Con en s lis s a ailable a ScienceDi ec
Bu nou Resea ch
jou nal homepage: www.else ie .com/loca e/bu n
Na a i es o bu nou and eco e y om an agency pe spec i e: A wo-yea
longi udinal s udy
S ela Salminen
a,⁎
, Elena And eou
a
, Juha Holma
a
, Mika Pekkonen
b
, Anne Mäkikangas
a,c
a
Depa men o Psychology, Uni e si y o Jy äskylä, Jy äskylä, Finland
b
Peu unka Rehabili a ion Cen e, Laukaa, Finland
c
Facul y o Social Sciences (Psychology), Uni e si y o Tampe e, Finland
ARTICLE INFO
Keywo ds:
In e iew
Na a i e analysis
Sphe es o meaning
Rehabili a ion
Occupa ional heal h
ABSTRACT
Pu pose: To p o ide knowledge abou he eco e y p ocess du ing ehabili a ion and wo yea s la e by ex-
plo ing he mani es a ion o agency and sphe es o meaning in he na a i es o pa icipan s in a na ional e-
habili a ion cou se.
Ma e ial and me hods: The subjec s o he s udy we e ou pa icipan s in a na ional ehabili a ion cou se, whose
bu nou le els had dec eased be ween he ini ial and ollow-up pe iods o he cou se. Semi-s uc u ed in e iews
on wo occasions and an elec onic ques ionnai e 1.5 yea s pos ehabili a ion comp ised he main ma e ial. In
addi ion, he BBI -15 (Be gen Bu nou Indica o ) and DEPS-sc een we e used.
Resul s: Thema ic na a i e analysis e ealed highly indi idual and he e ogeneous pa hs o eco e y. The fi s
pa s o he na a i es demons a ed a high deg ee o p oxy and collec i e agency. As eco e y p og essed
pe sonal agency was s eng hened. The sphe es o meaning pa icipan s a ached o hei s o ies also a ied, wi h
he ehabili a ion cou se and he p o essionals in ol ed being iewed as mo ally good. Th ee majo common
hemes we e iden ified: 1) he benefi s o he ehabili a ion cou se; 2) supe iso suppo ; and 3) pe sonal
ac o s.
Conclusions: Bu nou and eco e y a e no he consequence o wo k- ela ed o indi idual- ela ed ac o s alone,
bu a he he ou come o a combina ion o hese. Rega dless o common ac o s, he p ocess and he deg ee o
eco e y may a y. The mos beneficial pa h was obse ed when pe sonal agency was high and was ein o ced
by a suppo i e job en i onmen and a ou able pe sonal ac o s.
1. In oduc ion
Bu nou is a wo k- ela ed s ess diso de , which affec s a la ge
numbe o people o wo king age in indus ial coun ies. In Finland, in
he la es na ional ep esen a i e su ey conduc ed in 2011, 2% o men
and 3% o women in he wo k o ce suffe ed om se e e bu nou , while
he pe cen age o hose wi h mild bu nou was significan ly highe :
23% and 24% o men and women espec i ely (Duodecim, 2015). In
occupa ional heal h psychology, bu nou is ypically desc ibed as a
eac ion o long-las ing un ea ed occupa ional s ess, which is cha -
ac e ized by h ee symp oms: exhaus ion, cynicism and educed p o-
essional efficacy (Maslach, Jackson, & Lei e , 1996). I is no classified
as a medical disease, bu ins ead an addi ional code (ICD-10: Z73.0)
(Duodecim, 2015), which indica es he p esence o a p oblem ela ed o
li e con ol, is added o he diagnosis. The ela i ely high p e alence o
bu nou unde lines he need o a be e unde s anding o i s an e-
ceden s, de elopmen p ocesses and, abo e all, he pa hs o eco e y. In
esponse o his need, his s udy sough o cap u e subjec i e expe i-
ences om he onse o bu nou o eco e y.
Since bu nou in es iga ion began, a la ge body o esea ch –mainly
quan i a i e –has ocused on he causes, symp oms and consequences
o bu nou (Schau eli & Enzmann, 1998; Schau eli, 2000). Al hough no
single psychological heo y offe s a ull explana ion o bu nou , i is
commonly ag eed ha he causes o bu nou can be di ided in o h ee
ca ego ies (Schau eli & Enzmann, 1998;Schau eli, Maslach, & Ma ek,
1993): indi idual (bu nou is ega ded as he ou come o in ape sonal
ac o s); in e pe sonal (bu nou is seen as he esul o difficul ela ions
wi h o he s a wo k); and o ganiza ional (bu nou is iewed as a mis-
ma ch be ween he pe son and he job). Consequen ly, bu nou in e -
en ions ha e ocused on hese same ca ego ies o causes
(Schau eli & Enzmann, 1998). While ehabili a ion in e en ions ha e
been ound o exe a posi i e effec on bu nou educ ion (No lund
e al., 2011; S enlund, Ahlg en e al., 2009;S enlund, Bi gande ,
Lindahl, Nilsson, & Ahlg en, 2009;S enlund, No din, & Jä holm,
h p://dx.doi.o g/10.1016/j.bu n.2017.08.001
Recei ed 28 Ma ch 2017; Recei ed in e ised o m 9 Augus 2017; Accep ed 10 Augus 2017
⁎
Co esponding au ho .
E-mail add ess: [email p o ec ed].fi(S. Salminen).
Bu nou Resea ch 7 (2017) 1–9
2213-0586/ © 2017 The Au ho s. Published by Else ie GmbH. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/BY-NC-ND/4.0/).
MARK
2012), pa icula ly in he componen s o exhaus ion (Hä inen e al.,
2009;Hä inen, Kinnunen, Pekkonen, & Kalimo, 2007;Hä inen,
Mäkikangas, Kinnunen, & Pekkonen, 2013) and cynicism (; Hä inen
e al., 2007), he ocus ended o be on in es iga ing co ela ions be-
ween a iables a he han indi idual de elopmen al ajec o ies o
bu nou and eco e y (Mäkikangas & Kinnunen, 2016).
The ew quali a i e s udies on ehabili a ion ha e highligh ed an
impo an concep – ha o agency –and a gued ha he s eng hening
o agency is one o he p ima y goals in ehabili a ion in e en ions
(Jä ikoski, Ma in, Au i-Rämö, & Hä käpää, 2013). Theo e ically,
h ee diffe en modes o agency a e dis inguished: pe sonal, p oxy, and
collec i e (Bandu a, 2000). Pe sonal agency implies aking con ol o
exe cising influence wi h he aim o achie ing o p oducing gi en e -
ec s. In many cases, howe e , indi iduals a e unable o di ec ly impac
hei social en i onmen . Ins ead hey employ a media ed o m o
agency, p oxy agency, in which hey u n o o he s in possession o he
app op ia e esou ces, knowledge o means o ac on hei behal o
p oduce he ou comes hey desi e. The hi d mode, collec i e agency,
emphasizes he ac ha many ou comes a e achie able only h ough
join effo . A he co e o i is people’s sha ed belie in hei powe o
achie e desi ed ou comes.
Al hough o he s udies on bu nou ehabili a ion do no e e spe-
cifically o he concep o agency, hey iden i y simila hemes and
ca ego ies. In a s udy o an es ablished ehabili a ion in e en ion in
Finland, u ilizing he same baseline in e iew da a as in he p esen
s udy (Salminen, Mäkikangas, Hä inen, Kinnunen, & Pekkonen, 2015),
he impo ance o he accumula ion o suppo , awa eness and app o al
led clien s o he e ela ion ha hey a e p ima ily esponsible o hei
own well-being. The o e a ching heme o My well-being in my own
hands, which eme ged in he analysis, s ongly esembles he concep o
agency (Bandu a, 2000). Ano he s udy, conduc ed in Sweden, o pa-
ien s’expe iences o ehabili a ion consis ing o wo diffe en in e -
en ion g oups –one wi h cogni i ely-o ien ed beha iou al e-
habili a ion and QiGong (a p og amme combining ension- elie ing
mo emen s, elaxa ion and medi a ion), and he o he wi h QiGong
alone –p oduced simila esul s (Fjellman-Wiklund, S enlund,
S einhol z, & Ahlg en, 2010). Du ing he eco e y p ocess, pa ien s
emphasized he beneficial effec s o affi ma ion and suppo om e-
habili a ion p o essionals and g oup membe s, in enabling hem o e-
s o e con ol o e hei li es. Despi e hei con ibu ion o he unde -
s anding o he mechanisms o change, a common ea u e o hese
s udies is he use o a c oss-sec ional design, which does no yield
sufficien in o ma ion abou pa icipan s’pos -in e en ion expe i-
ences.
To ou knowledge, he e a e no published quali a i e s udies which
ha e acked he de elopmen o he eco e y p ocess o e ime. To fill
his gap, he p esen s udy is a pilo esea ch comp ising ou na a i es,
which se s ou o in es iga e he en i e p ocess om he onse o
bu nou o eco e y a diffe en ime poin s du ing and a e e-
habili a ion. The main ocus was on he con en o he na a i e, i.e., on
wha pa icipan s old abou he a ious s ages o he p ocess. As he
ein o cemen o agency is an impo an goal in ehabili a ion and i s
significance has been demons a ed in p e ious s udies (Jä ikoski
e al., 2013; Salminen e al., 2015), a u he aim was o explo e he ole
o he h ee modes o agency (pe sonal, p oxy and collec i e) in mo e
dep h along wi h hei impac on eco e y wi hin his sample. Na a i e
inqui y was chosen as he p ima y me hod o in es iga ion, as eco e y
pa hs a e ypically indi idual and he e ogeneous (; Hä inen e al.,
2013).
1.1. Na a i e analysis
Na a i es enable he explo a ion o human expe ience in a holis ic
manne by p ese ing i s ich and complex na u e (Bell, 2002) and
ecognizing li ed expe ience as a sou ce o knowledge and unde -
s anding (Clandinin, 2013). Wi hin he amewo k o na a i e
esea ch, a ple ho a o diffe en defini ions, app oaches, and specific
me hods exis s (Pinnega & Daynes, 2007). Fo he pu poses o his
s udy, hema ic na a i e analysis, as desc ibed by Ca he ine Riessman
(2008), was applied. I is one o he mos commonly used ypes o
na a i e analysis, and one in which exclusi e emphasis is placed on he
con en o he s o y old. While p ese ing he ea u es o he indi idual
na a i es, his ype o analysis enables iden ifica ion o common he-
ma ic elemen s ac oss he pa icipan s’accoun s (Riessman, 2004). This
ype o analysis, wi h i s exclusi e ocus on na a i e con en , was
conside ed pa icula ly sui ed o cap u ing bo h pa icipan s’expe i-
ences o e ime and he meanings hey a ibu e o he p ocess o e-
co e y.
A he co e o na a i e inqui y lie ques ions abou wha he s o y
e eals abou he pe son and his/he wo ld and wha ligh in e p e a-
ion o he s o y can shed on he cul u al and social milieu in which he
na a i e is p oduced (Pa on, 2015). In cons uc ing hei s o ies, in-
di iduals bo h inco po a e hei unde s anding o he su ounding
wo ld in o he ab ic o hei na a i es and engage in a sense-making
p ocess. Se e al sphe es o meaning –emo ional, explana o y, mo al
and e hical –can be disce ned in na a i es (Hänninen & Koski-Jännes,
1999) and hese a e explo ed in his s udy. Emo ional sphe es o
meaning e e o he emo ional unde pinning o a na a i e –whe he
he goals o he main cha ac e a e achie ed o hwa ed, whe he he
s o y has a posi i e (happy) o nega i e ( agic) ending, wha i s high
and low poin s a e (Ge gen, 1988). The explana o y pe spec i e is e-
la ed o he manne in which e en s a e linked wi h each o he as
causes and consequences. The mo al sphe e o meanings deals wi h he
alloca ion o esponsibili y o e en s and whe he he e a e elemen s o
accusa ion o excuse in he na a i e (Baumeis e & Newman, 1994).
The e hical aspec a icula es he deepe esona ing elemen s o good
and bad as well as igh and w ong in li e. Thus, in addi ion o he
mani es a ion o agency and he explo a ion o he en i e p ocess o
eco e y, hese ou sphe es o meaning a e all disce nible in he pa -
icipan s’na a i es. Thei iden ifica ion p o ides a ye deepe le el a
which subjec i e expe iences can be cap u ed, while simul aneously
e ealing impo an pe cep ions abou he b oade social and cul u al
milieu in which he na a i es a e p oduced.
2. Ma e ial and me hods
2.1. S udy design, pa icipan s and da a collec ion
This s udy comp ises he na a i es, collec ed on h ee occasions, o
ou pa icipan s in a Finnish na ional ehabili a ion cou se. These
cou ses we e s a e financed, i.e., he Finnish Social Insu ance Ins i u ion
unds ehabili a ion se ices and p o ides income du ing pa icipa ion
in he cou se. Pa icipan s ei he apply o a e e e ed by hei occu-
pa ional heal h ca e se ice o a bu nou in e en ion. Applican s and
e e als a e sc eened by he local b anch o he Social Insu ance
Ins i u ion and he final selec ion is made by a physician om he e-
habili a ion cen e. These ehabili a ion cou ses s a wi h a 10-day
pe iod and end wi h a ollow-up pe iod, which akes place wi hin a
mos 7 mon hs a e he fi s pe iod. Rehabili a ion includes an e a-
lua ion o an employee’s physical and psychological s a us by a ious
p o essionals, including a physician, psychologis , physio he apis , and
social wo ke . The ehabili a ion ac i i ies in bu nou in e en ions
ocus p ima ily on enhancing indi idual esou ces and suppo ing
coping s a egies. This is achie ed h ough a ious indi idual- and
g oup-le el ac i i ies. Indi idual-le el ac i i ies, which accoun o 11 h
o he 70-h ehabili a ion p og amme, include guidance and counselling
wi h a ious ehabili a ion p o essionals, es s and examina ions, and
specific asks o be comple ed be ween he ehabili a ion pe iods.
G oup-le el ac i i ies, amoun ing o 59 h, comp ise physical exe cise,
educa ion on nu i ion, e gonomics and heal h, and pa icipa o y g oup
discussions.
Pa icipan s o his longi udinal s udy we e selec ed om a ious
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
2
ehabili a ion cou ses ha ook place in 2012 a a ehabili a ion cen e
in Cen al Finland (Salminen e al., 2015). O he h ee ehabili a ion
cou ses wi h a ollow-up pe iod be ween Augus and Decembe 2012,
15 eligible employees, whose bu nou le els had dec eased, we e
iden ified, and 12 pa icipa ed in he fi s phase o he s udy (Salminen
e al., 2015). The psychologis a he ehabili a ion cen e in o med
clien s whose bu nou sco e had diminished o he possibili y o pa i-
cipa e in he s udy. Thei willingness o pa icipa e in he ollow-up
phases o he s udy was also inqui ed. The baseline le els o bu nou
and he subsequen change we e measu ed wi h he Be gen Bu nou
Indica o (BBI-15) (Nää änen, A o, Ma hiesen, & Salmela-A o, 2003).
The BBI-15 comp ises he h ee symp oms o bu nou : exhaus ion, cy-
nicism and educed p o essional efficacy. To al sco es a y be ween 15
and 90, o ming ou diffe en classes o bu nou : se e e, mode a e,
mild and no bu nou . Eligibili y was de e mined i he bu nou symp-
oms had dec eased by a leas one class and in a leas one sub-di-
mension. The fi s in e iews, which p o ide accoun s o bu nou de-
elopmen and expe iences o he ehabili a ion cou se we e conduc ed
a e he end o he cou se ollow-up pe iod in he au umn o 2012 on
ehabili a ion cen e p emises (Salminen e al., 2015).
Pa icipan s we e app oached 1.5 yea s la e (in Sp ing 2014) ia an
elec onic ques ionnai e sen o hei p i a e e-mail add esses. The
ollow-up ques ionnai e measu ed pa icipan s’bu nou and dep ession
sco e wi h he BBI-15 (Be gen Bu nou Indica o , BBI-15, Nää änen
e al., 2003) and wi h he DEPS-sc een (Salokangas,
Pou anen, & S enga d, 1995). The ques ionnai e also included open
ques ions, in which pa icipan s we e asked o e alua e, e.g., hei
manage ’s ac i i ies, changes ha had occu ed a wo k and he impac
diffe en ehabili a ion ac o s had had on hei well-being. A eminde
o hose who had no answe ed was sen a he end o May 2014. Nine
ou o wel e pa icipan s sen back he filled-ou ques ionnai e. O he
h ee pa icipan s who did no espond, one was on sick lea e a he
ime o da a collec ion and hus did no ecei e in o ma ion abou he
ques ionnai e. The o he wo pa icipan s could no be eached.
O he nine esponden s, eigh ga e hei consen o be con ac ed o
u he inqui y. O hese eigh , ou we e selec ed h ough pu pose ul
sampling (Pa on, 2015) o an in-dep h in e iew wi h a iew o col-
lec ing diffe ing s o ies o bu nou and eco e y. The sampling was
based on he deg ee o eco e y (con inued eco e y o wo sened
bu nou ) and on whe he job change had aken place ( wo o he pa -
icipan s had changed jobs and wo we e in he same job). They we e
app oached by e-mail and hei willingness o pa icipa e in a ollow-up
in e iew was elici ed in Oc obe 2014. Sample age a he las da a
collec ion poin a ied be ween 41 and 64 yea s (mean 55.8 yea s).
Two o he pa icipan s had a oca ional school educa ion, one had
comple ed a p o essional poly echnic qualifica ion and one had a uni-
e si y deg ee. Time wi h he cu en employe a ied be ween 3
mon hs and 40 yea s. All pa icipan s we e cu en ly wo king, bu one
was on pa - ime e i emen . The ou pa icipan s whose eco e y
p ocess was explo ed in mo e de ail we e in e iewed by means o a
hema ic in e iew by a Mas e ’s s uden o Psychology in No embe -
Decembe 2014. The in e iews we e conduc ed in a quie place in he
pa icipan ’s home. Each in e iew las ed be ween 1 and 1.5 h. The
in e iews we e ansc ibed e ba im; howe e , he p ecise leng h o
pauses, s u e s and o he sounds, and non- e bal language we e no
w i en down as he main emphasis was on he con en o he s o y old.
The o al leng h o he ansc ibed in e iew ma e ial om he fi s and
hi d da a collec ion poin s was 138 pages, while he ques ionnai e
adminis e ed a he second da a collec ion poin was 12 pages in leng h.
2.2. Da a analysis
The accoun s gi en a hese h ee da a collec ion poin s we e e-
ga ded as h ee pa s o he same pe son’s na a i e. This app oach was
adop ed o honou he longi udinal design o he s udy and, mo e im-
po an ly, o allow he acking o change o e ime h ough
compa ison o each pa icipan ’s desc ip ions o bu nou and eco e y
a he diffe en ime poin s, and o he diffe en social condi ions and
places in which he da a had been collec ed. This acco ds wi h he h ee
commonplace ea u es o na a i e inqui y posi ed by Connelly and
Clandinin (2006): a en ion o empo ali y, sociali y, and place. Tem-
po ali y e e s o he con inui y o expe ience and he ac ha people
and e en s a e si ua ed in ime and a e desc ibed wi h a pas , p esen
and u u e. The sociali y commonplace eflec s he no ion ha pe sonal
and social condi ions shape he indi idual’s con ex . The hi d com-
monplace d aws a en ion o he ac ha all e en s occu in a conc e e
physical place. In line wi h Riessman’s (2008) p esen a ion o hema ic
na a i e analysis (p. 54), da a we e in e p e ed in ligh o he agency
heme, which se ed as he heo e ical amewo k o he s udy, i.e., he
pa icipan s’accoun s we e iewed h ough he lens o agency and how
i s diffe en modes we e in e wo en he ein. In he analysis, he ocus
was on he con en o he na a i es, i.e., on wha pa icipan s epo ed
abou he p ocess, and no on how hey epo ed abou i . Fu he mo e,
he choice o na a i e analysis was jus ified as we wan ed o iew he
na a i es as whole en i ies ins ead o iden i ying ca ego ies as, o
example, is done in o he ypes o quali a i e analysis.
The na a i es o each pa icipan om he h ee collec ion poin s
we e fi s ead o g asp he gene al meaning and spi i o he s o y.
Du ing successi e eadings we ocused on unco e ing he pa icula
manne in which he pa icipan econs uc ed he o ma ion o
bu nou , how change s a ed o eme ge in he s o y, pa icula ly in he
ehabili a ion s age, and how he p ocess had con inued a 1.5 and 2
yea s a e he end o he ehabili a ion cou se. While eading, we a -
emp ed o disce n all h ee modes o agency as well as he p esence o
weak agency o he absence o agency. Once we had ob ained a be e
unde s anding o he s o y, we p oceeded o iden i y i s emo ional,
causal, mo al and e hical aspec s. These we e based exclusi ely on he
pa icipan s’subjec i e expe iences and hei in e p e a ion o he
e en s be o e and du ing he bu nou s age and h oughou he e-
co e y pe iod. Finally, we assigned a i le o he na a i e, which e-
flec ed i s co e meaning. When he na a i es o all he pa icipan s
we e analysed, we isola ed he mos impo an common hemes o
close examina ion. The common hemes we e ecu ing opics, e en s
o ac o s, ound in all ou na a i es, which we e expe ienced as
pa icula ly impac ul in he whole p ocess, and we e hus indica i e o
ei he success ul o impeded eco e y. The pa icipan s we e iden ified
by a pseudonym o gua an ee hei anonymi y and a oid any isk o
hei being ecognized based on he na a i e p esen ed in he s udy.
2.3. C edibili y
To inc ease he c edibili y o he s udy, he pa icipan s we e o i-
ginally selec ed om h ee diffe en cou ses. The ehabili a ion cou ses
comp ise a lo o g oup exe cises, which aim o enhance g oup cohe-
si eness. Howe e , his may lead o g oup hink, and inhibi he ex-
p ession o indi idual and diffe ing opinions. By s udying pa icipan s
om diffe en g oups, we aimed o minimize his effec . To inc ease he
c edibili y and in e p e i e po en ial o he s udy, da a iangula ion
based on (1) a sel - epo ques ionnai e (BBI-15); (2) a w i en ques-
ionnai e a Time 2; and (3) semi-s uc u ed in e iews a Time 1 and 3,
was used (Denzin, 1970).
2.4. E hical conside a ions
The s udy was app o ed by he E hical Commi ee o he Uni e si y
o Jy äskylä, Finland. The s udy was in oduced o he ehabili a ion
cen e clien s by he psychologis , who p o ided hem wi h w i en
ma e ials. The olun a y na u e o pa icipa ion, anonymi y and con-
fiden iali y we e emphasized be o e he s a o he s udy and we e
men ioned a each subsequen s age o he da a collec ion. The pa i-
cipan s signed a consen o m and we e in o med o he possibili y o
discon inue hei pa icipa ion a any ime du ing he s udy wi hou any
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
3
consequences. A consen o audio eco ding was also eques ed.
Rehabili a ion s aff ep esen a i es we e no p esen a any poin du ing
he in e iews.
3. Resul s
3.1. Sa a, age 57, kinde ga en eache , di o ced: “Change is he only
cons an ”
Sa a’s na a i e e eals he s o y o a woman who ound he sel
g appling wi h massi e and cons an changes in he wo kplace
(Table 1). As hese changes spun ou o he con ol, hey affec ed he
well-being and e en ually led o e y se e e bu nou . I is impo an o
no e ha she did no pe cei e ha he bu nou was caused by he
na u e o he wo k, pe sonal conflic s o eam- ela ed schisms, bu as a
esul o he apid accumula ion o changes, which unde mined he
eeling o belonging, ole cla i y and p o essional iden i y.“Wha hen
s a ed inc easing my eelings o bu nou was he cons an , incessan change
and he ac ha he e was no s abili y o cla i y. I mysel had he eeling
some imes ha I don’ know who I am anymo e, le alone a he ime when I
was my colleague’s supe iso o a yea –a yea and a hal , and hen all o
a sudden I was an o dina y line wo ke alongside ellow wo ke s.”
He pe sonal agency was p esen in he bu nou s age in he effo s
o call he managemen ’s a en ion o he de imen al effec s o he
cons an o ganiza ional changes, bu his mode o agency seemed o
lack efficacy and ailed o make an impac on he o e all si ua ion.
“When we hen s a ed alling ill and aking sick lea e absences and
subs i u es came in, and hey s a ed alling ill, hen occupa ional
heal hca e s a ed o ake an in e es in ou p oblem, he hing is ha we
ied e y ha d o communica e his and sp ead he wo d ha hings a e
no all igh he e, bu simply no hing happened.”
The ques ion o he accumula ion o s ess becomes pa icula ly
e iden he e: as Sa a’s bu nou co-occu ed wi h physical ailmen s and
amily p oblems (di o ce), she a ibu ed he symp oms o exhaus ion,
loss o p o essional p ide and cynicism o hese p oblems and hus
ailed o ecognize he p ima y cause o he bu nou .
“You a e as bu n ou as you could possibly be…you eally need a
b eak...I mysel hough in a way ha … ha I ha e o demand mo e and
mo e om mysel , I ha e o jus manage and cope wi h i , and so...I jus
didn’ ealize how deep I was in my own bu nou .”
The high poin in Sa a’s na a i e was a he end o ehabili a ion,
which she saw as good, use ul and affi ma i e. She also p aised he ole
o he daugh e and pe dog, who ga e he he gen le push she needed
o eco e y. He pe sonal agency emained somewha in he back-
g ound, whe eas p oxy agency (help om ehabili a ion p o essionals
as well as amily membe s) and collec i e agency (help om he e-
habili a ion g oup) we e boos ed.
A e he fi s change o job, Sa a con inued on he oad o eco e y,
bu soon he same p oblems as in he p e ious wo kplace s a ed o
eme ge. She had h ee diffe en manage s du ing he wo yea s she
spen in he second wo kplace. Thus, he accoun o he e en s du ing
he 1.5 yea s a e ehabili a ion, was inged wi h disappoin men : e-
plica ion o he same p oblems a e he change o job ollowing he
ehabili a ion cou se led o se e e bu nou , as also iden ified by he
sco e on he bu nou scale (BBI-15). E en ually, a e his fi s job
change she mo ed o he hi d wo kplace, sho ly be o e he in e iew
wo yea s a e he ehabili a ion cou se.
The hi d sub-na a i e was e alua i e and e aced he ull spec-
um o e en s and emo ions accompanying he bu nou , ehabili a ion
and p esen s a e o well-being. Sa a also discussed he effec s o pe -
sonnel u no e and he lack o s abili y in he wo kplace, hus a -
aching a mo ally nega i e meaning o he la e . I is no ewo hy ha
despi e he disappoin men caused by he fi s job change he na a ion
o e en s was in o med by a ce ain deg ee o awa eness and se eni y.
She was able o offse he ull de elopmen o bu nou by demons a ing
p oac i i y, exe cising pe sonal agency and changing jobs again. The
emo ional one in he hi d sub-na a i e was cau iously op imis ic and
p onouncedly ealis ic, and Sa a was no esigned o helplessness o
hopelessness. Pe sonal agency was mani es ed in he in en ions o keep
looking o a sa is ying job:
“I hasn’ a any poin en e ed my mind, oh, wha did I do, I mean I
ha en’ hough , did I make he igh decision o any hing like ha ...I
ha en’ eally…and I saw ha my coming o X. (he new wo kplace)
happened jus a he igh poin , i was good…[…]. My ea lie wo k-
places we e somehow...I always had o s a om sc a ch and again om
sc a ch and c ea e ou ines…and I would ha e liked o c ea e some hing,
o d i e some hing o wa d, bu he eali y o wo k somehow de ou ed so
much. […] Now I eel I wan o look a all he possibili ies…’cos you
know his job can be done in so many diffe en ways…and especially
he e in [ his] a ea he e a e so many ways…and i ’s an expe ience o
me.”
The ac ha Sa a had mo ed o a new wo kplace p io o he in-
e iew explained why he na a i e emained open-ended. She e-
cognized ha he eco e y was a long p ocess and was awa e ha she
was no ye ully eco e ed. She hoped o a be e ou come his ime,
and allowed he sel o explo e u he oppo uni ies, should he igh
momen a ise.
Sa a’s pe sonal agency, al hough exis en , was ende ed ineffec i e
and u ile by poo managemen o p oblems in he wo kplace. P oxy
and collec i e agency we e he mos ac i ely exe cised du ing e-
habili a ion, which in u n boos ed he pe sonal agency.
The main cause o de eloping bu nou we e he cons an o gani-
za ional changes, which unde mined Sa a’s eeling o s abili y, blu ed
he ole cla i y and obbed he o he sense o belonging and con ol.
The na a i e blamed he mul i ude o , in he iew, poin less changes in
he wo kplace which we e no handled adequa ely by he managemen .
C edi was gi en o amily membe s (daugh e and dog), who p o ided
suppo wi hou passing judgemen . On a deepe , alue-d i en le el,
Sa a saw he a i ude o dis espec and dis ega d o he suffe ing as
e hically bad e en when hese we e openly aised. Wha Sa a empha-
sized as e hically good was he suppo , despi e all he suffe ing, p o-
ided by occupa ional heal h ca e, he ehabili a ion p o essionals and
amily membe s.
3.2. Diana, age 61, ecep ion nu se, ma ied: “Eyes se on e i emen ”
Diana’sna a i e ep esen s he pa h o an employee who suffe ed
om se e e bu nou , which could no be comple ely ea ed, and who
expec s e i emen o esol e he p oblem (Table 2).
Fo Diana, he accumula ion o s esso s leading o exhaus ion was
some hing ha s a ed a long ime ago, when he numbe o ecep ion
nu ses emained unchanged while he amoun o wo k s eadily in-
c eased. Be o e he onse o he bu nou Diana desc ibed he wo king
condi ions as inadequa e and he o ganiza ional clima e as
Table 1
Open-ended na a i e “Change is he only cons an ”.
Massi e cons an changes −> e y se e e bu nou −> ehabili a ion 1s
pe iod −> change o job −> ehabili a ion ollow-up pe iod −> imp o ed
well-being −> exace ba ion o he wo k si ua ion −> change o
job −> mixed eelings/cau ious op imism −> con empla ion o
change −> open-ended na a i e
Emo ional one: mix u e o op imism and disappoin men
Explana o y: cons an changes, no fi m g ound
Mo ally blamed: he lack o s abili y unde mines one’s ounda ions; p oblems a e no
aken se iously by managemen
Mo ally p aised: daugh e and dog
E hically good: p esence o suppo
E hically bad: being ea ed wi hou espec ; being obbed o p o essional digni y
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
4
unsuppo i e. Employees’needs we e dis ega ded and he managemen
ailed o eac o inequali ies. He hopes o imp o emen we e sha e ed
when, con a y o p omises, an ex a pe son was no hi ed, which led
he o see he sel as a ic im o se e e injus ice. I was a his poin ha
Diana el she could no longe cope, and she s a ed complaining o
s omach aches and sleeplessness, which in u n led o inc eased ex-
haus ion and sensi i i y.
“And hen he momen came… ha I couldn’ cope anymo e. I had
somehow managed up o when hey p omised again and again ex a help,
bu hen in he win e i jus came o he poin whe e I couldn’ cope
anymo e. I had come up agains a wall.”
An addi ional bu dening ac o men ioned by Diana was he sick
mo he who equi ed daily ca e and axed he esou ces. Th ough ex-
e cising p oxy agency, wi h he help o occupa ional heal h ca e p o-
essionals and he ehabili a ion cou se, Diana was able o mode a e he
bu nou symp oms and achie e an imp o emen in he well-being. This
was ansla ed in o inc eased ene gy le els and he mo i a ion o en-
gage in mo e physical exe cise. Howe e , Diana’s ocus ega ding he
means o eco e y lay mainly in educing he wo kload and being
g an ed pa - ime e i emen . She ecognized he impac o he physical
ailmen s on he well-being, and hus he effo s we e di ec ed owa ds
minimizing s ain a he han achie ing ull eco e y in o de o e u n
o he p e-bu nou wo k capabili y.
This sligh ly passi e app oach o eco e y p esumably led o an
in e es ing disc epancy be ween he measu ed le els o bu nou and he
bu nou she epo ed a he second ime poin . Al hough Diana’s o e all
bu nou sco e diminished be ween he fi s and second da a collec ion
ime poin s, she ne e heless epo ed an inc ease in bu nou symp-
oms. Such a misma ch could pe haps be accoun ed o by he ap-
p oaching ull e i emen age as well as he a ious physical ailmen s
she suffe ed om. P esumably, she in es ed less effo in eco e y, i.e.,
she exe cised pe sonal agency on a smalle scale, and ins ead ocused
he a en ion on e i emen .
The las pa o he na a i e a wo yea s pos - ehabili a ion was
mo e con empla i e and o ien ed owa ds he amily. Bo h sides o he
bu nou and eco e y p ocess we e oiced. The o e all one became
mo e philosophical as ealisa ion o one’s age and fini eness g ew. In
ela ing he expec a ions o he u u e, Diana exp essed a wish o be
heal hy and able o spend ime wi h he child en and g andchild en.
Hence, he pe sonal agency was mo e di ec ed owa ds eaching and
main aining good physical heal h so as o be fi o se e he amily
membe s.
“I’m wai ing o e i emen and hen I hope I’ll be heal hy again, so ha
we can a el and ha e hobbies, and hen o cou se ha I’ll ha e he
ene gy o ake ca e o my g andchild en and play wi h hem… his is a
wonde ul ime ha I’m looking o wa d o.”
In Diana’s na a i e, p oxy agency is he mos p ominen mode o
agency and he mode exe cised mos ac i ely ac oss he s udy pe iod.
Diana holds expe s’ ips and ecommenda ions in high ega d and e-
lies s ongly on hei knowledge and encou agemen . Occupa ional
heal h ca e and ehabili a ion p o essionals along wi h he
ehabili a ion g oup played a significan ole in he p ocess o eco e y
and hey emained ins umen al in main aining i . Pe sonal agency was
also iden ifiable in he accoun , al hough o a lesse deg ee. I was e-
ac i a ed du ing and a e he ehabili a ion cou se, and was p ima ily
isible in Diana’s a emp o main ain a heal hie li es yle h ough
spo s and balanced nu i ion.
The o e all emo ional one was o sligh esigna ion and a igue,
al hough in he las pa hope and expec a ions o he u u e we e also
oiced. The na a i e did no incline owa ds a posi i e o a nega i e
end, bu could a he be ca ego ized as suspended. The cause o bu nou
was pe cei ed as wo k o e load and he lack o an adequa e o gani-
za ional esponse he e o, combined wi h pe sonal ailmen s. F om a
mo al pe spec i e, he ehabili a ion p og amme and he pee suppo
we e p aised whe eas he dis ega d o employees’suffe ing and he
injus ice inexpe ienced we e ha shly blamed. On a deepe le el o a-
lues, Diana iewed he wo k e hic and he connec ion o he amily
membe s as good and he injus ice pe pe a ed owa d a pa icula
employee g oup as e hically e il.
3.3. Paula, age 41, managemen sec e a y, ma ied: “The success ul job
change ”
Paula’s na a i e desc ibes he bu nou and eco e y p ocess,
s a ing om b eakdown o he egaining o joy and cla i y by means o
a men al shi (Table 3). She depic s he accumula ion o an excessi e
wo kload, o which she esponded wi h habi ual conscien iousness, and
he implemen a ion o manage ial changes. Paula ealised ha he
amoun o wo k was becoming in ole able, bu despi e he a emp s o
b ing he p oblems o unde s affing o he managemen ’s a en ion, he
conce ns we e no adequa ely esponded o and no hing changed o
ligh en he bu den. Simul aneously, she had heal h p oblems which
caused a igue and p e en ed he om ecognizing ha she had
symp oms o bu nou . She also s a ed suffe ing om sleeplessness and
anxie y o e unfinished wo k un il he b eakdown, which happened
“o e nigh ”. Wi h egula help om occupa ional heal h ca e p o es-
sionals (a physician, a heal h nu se and a psychologis ), in o he wo ds,
h ough exe cising p oxy agency, she was able o a icula e he p o-
blems and become awa e o he bu nou . The iden ifica ion o he
p oblem igge ed an ini ial eac ion o ea :
“I was aw ully sca y…you know, all o a sudden I can’ manage any-
mo e. Bu he sca y hing was ha I had been walking wi h my eyelids
shu , in a unnel. And i (bu nou ) had been he e o a long ime, bu I
hadn’ ealized i mysel . So… ea was he bigges hing, I guess.”
Paula demons a ed ini ia i e and sough he se ices o a p i a e
he apis o gain an ou side pe spec i e on he s a e. She also spoke
abou he eno mous g a i ude she el owa ds he dog, who was by he
side, non-judgemen al and suppo i e, h oughou he en i e p ocess.
A e se e al s in s o sick lea e, she e u ned o wo k pa - ime, bu
con inued on pa ial sick lea e. Specific changes ega ding he di ision
o labou we e in oduced and ag eed upon in w i ing, and an addi-
ional pe son was hi ed o ligh en he wo kload.
Table 2
Na a i e “Eyes se on e i emen ”.
Inadequa e wo k condi ions and ch onic o e load −> se e e
bu nou −> ehabili a ion −> Ha nessing bu nou −> Subjec i ely pe cei ed
exhaus ion −> pa - ime e i emen −> looking o wa d owa ds ull
e i emen
Emo ional one: esigna ion and a igue
Explana o y: wo k o e load and lack o adequa e esponse he e o; physical ailmen s
Mo ally blamed: injus ice
Mo ally p aised: ehabili a ion p o essionals and pa - ime e i emen
E hically good: own wo k e hic
E hically bad: pe cei ed injus ice
Table 3
Na a i e “The success ul job change ”.
Excessi e wo kload −> Unawa eness o he symp oms −> U e exhaus ion and
b eaking down o e nigh −> Occupa ional heal h ca e suppo −> S in s o
sick lea e and commencemen o eco e y −> Re u n o
wo k −> Rehabili a ion −> P ocessing −> Job
change −> Re i al −> Main enance o balance
Emo ional one: e i al
Explana o y: excessi e wo kload combined wi h ex eme conscien iousness
Mo ally blamed: wo k e hic in he childhood amily
Mo ally p aised: ehabili a ion
E hically good: men al ma u a ion
E hically bad/e il: pe cei ed injus ice
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
5

Fo Paula, ehabili a ion came a e he acu e s age o bu nou had
been o e come and he ini ial phases o eco e y had commenced. She
belie ed his enabled he o benefi om i he mos and she desc ibed
he expe ience hus:
“[Wha did ehabili a ion mean o you?]
P: Pausing…and comple e and ho ough p ocessing o hese hings. I has
been…le ’s see how I am, how I eel. Pe haps I had always pushed mysel
in o he backg ound be o e, o make oom o o he hings. So [in ehab]
I could be mysel , o mysel . ”
Paula had o go h ough a p o ound and ho ough p ocess o e-
p io i izing he alues: coming om a amily wi h en ep eneu -mo-
he , Paula belie ed ha wo k had o be done and was op p io i y.
Posi ioning he own well-being highe in he hie a chy equi ed con-
scious effo and pe sonal agency, bu he ou come, al eady a he fi s
ime poin , was imp o ed wo k-li e balance. O e all, despi e he posi-
i e changes, Paula was awa e ha he p ocess o eco e y was slow
and ime-consuming, and she admi ed he possibili y o a enewal o
bu nou . As a p e en i e measu e, Paula b ough up “ alking ea lie ”
and “s ongly desi ing change”.
Fac o s hinde ing eco e y we e ela ed o he managemen , who
ins iga ed he subsequen changes. P oblems wi h he indi ec supe -
iso led o an inc ease in bu nou symp oms. Wi h he help o he
di ec line manage , who was suppo i e and help ul, she was ans-
e ed o ano he uni wi hin he same o ganiza ion be ween he fi s
and second da a collec ion poin s.
A he second ime poin , Paula expe ienced a lo o posi i e
changes. She el accep ed and welcome in he new eam, enjoyed
g ea e esponsibili y and was able o c a he job mo e eely. Despi e
he long dis ance be ween he home and he wo kplace, Paula el ha
she was in cha ge o he li e again, which in u n had a posi i e effec
on he ela ionship wi h he husband and child en. The emo ional one
o he na a i e was ela ed and hope ul. The amoun o pe sonal agency
she exe cised had g own and was isible in he mo i a ion o engage in
spo s, ea heal hily and main ain he well-being. She also ac i ely e-
isi ed he lessons lea n du ing ehabili a ion and could now see he
bu nou in a posi i e ligh :
“Bu nou can affec anyone. I am happy I wen h ough ha hell, because
I was able o g ow as a pe son.”
Paula’s s a e wo yea s a e ehabili a ion (a T3) was good, al-
hough a he ime o he in e iew she was on a sick lea e due o
physical ailmen s. She was able o eflec mo e ex ensi ely on he
change o job and he app ehension she had el a ha ime. He mo-
i a ion o a oid bu nou o be able o de ec i in ime was isible in
he conscious moni o ing o he s a e, in he effo s o keep he wo k-
load wi hin manageable p opo ions and in he abili y o lis en o he
body’s signals, all o which a e mani es a ions o enhanced pe sonal
agency. P oxy agency was exe cised h ough he supe ision p o ided
by he wo kplace, which se ed as a o um o sel - eflec ion and ad-
di ional moni o ing o he well-being. Paula had adop ed a new mindse
h ough a men al shi :
“I’ e ealised I’m no omnipo en […] a kind o anquilli y has se led
in…being me ci ul o onesel […]I’ e done so much… ha I find joy in
hings in a new way o in a bigge way han ea lie . Ea lie I would ha e
s a ed a he unfinished wo k…oh, he e a e s ill so many hings o do,
and I’ e only done his…now i ’s he o he way a ound: I ha e finished so
much, and well, he e a e s ill unfinished asks…bu hey don’ s ess
me...I’ll ge down o hem nex .”
A ac o axing he esou ces was he mo he , who was eco e ing
om cance , bu his was coun e balanced by an inc eased pool o
physical, men al and in e pe sonal esou ces. Howe e , she epo ed an
enhanced ma u i y and p udence in accep ing addi ional asks. In
summing up he main easons o he eco e y Paula ga e c edi o he
ehabili a ion p og amme o p o iding he wi h aluable knowledge
abou bu nou and helping he adop a mind ul a i ude and an abili y
o be p esen . She exp essed g a i ude o he husband, who had been a
sou ce o suppo du ing he bu nou pe iod, and was hank ul o he
oppo uni y o ha e a new ewa ding job. He ision o he u u e was
posi i e and mo e amily-o ien ed.
Paula demons a ed a lo o pe sonal and p oxy agency, bo h a he
beginning, p io o he de elopmen o bu nou , du ing he sick lea e
and a e ehabili a ion. I is no ewo hy, howe e , ha pe sonal
agency, e en when p esen , ailed o lead o he desi ed esul s a he
wo kplace. The es o a ion o balance was a slow p ocess in which
pe sonal agency was suppo ed h ough he deploymen o p oxy and
collec i e agency. He ex ensi e use o occupa ional heal h ca e was
essen ial no only in aising awa eness and ini ia ing a men al shi , bu
also in building obus pe sonal agency in he o m o asse i eness and
sel -me cy.
Paula held he accumula ion o excessi e wo kload and he mindse
o being in cha ge accoun able o he de elopmen o he bu nou . This
combina ion gene a ed a icious ci cle o inc easing ex a du ies and an
inabili y o pu a s op o i . B eaking poin was eached “o e nigh ”. She
ound aul wi h he wo k mo ali y adop ed in he childhood amily,
whe eas she p aised he ehabili a ion p og amme. On a deepe le el o
alues, “e il”was seen in he injus ice p esen in he wo kplace, in
which employees we e no ea ed equally. The e hical i ue in u n
can be seen in Paula’s men al ma u a ion. He men al awakening and
s eng hening o pe sonal agency, which occu ed h ough he ecep-
ion o ex e nal help, ans o med he om being a ic im in o being an
ac i e agen .
3.4. As id, age 64, di ec o , ma ied: “Tu ning being ma ied o he job in o
a happy ma iage”
As id’s na a i e is an example o success ul eco e y (Table 4). I
demons a es well he eco e y o pe sonal agency in a balanced
manne , al hough i should be bo ne in mind ha he ini ial bu nou
le el was no high. As id el he onse o bu nou wo yea s be o e he
ehabili a ion cou se, when he pace a wo k in ensified and she s a ed
ha ing p oblems sleeping. As id’s exhaus ion was he main eason she
sough help and pa icipa ed in ehabili a ion. The p essu e caused by
wo k was in ensified by pe sonal ac o s (he husband’s disease and
agg a a ed poo heal h) and accele a ed by he own heal h p oblems,
which axed he physical and men al esou ces. The onse o bu nou
also caused As id o e hink wha wo k mean o he : al hough she was
close o e i emen she did no wan o lea e he li e’s wo k unfinished.
He esponse o bu nou was p oac i e and pe sonal agency was
disce nible in se e al aspec s: she sough means o alle ia e he si ua-
ion by lea ning o delega e, by accep ing social suppo om iends
and colleagues, and by lis ening o music. The p og amme ga e As id
many ake-home messages and led he o make significan shi s in he
hinking and in he pe cep ion o he own bounda ies. She became
awa e o he endency owa ds pe ec ionism and adop ed a mo e
me ci ul and sel -app o ing a i ude. He well-being e en s a ed
Table 4
Na a i e “Tu ning being ma ied o he job in o a happy ma iage”.
P essu e a wo k and conce ns abou husband’s
heal h −> exhaus ion −> unawa eness o he own s a e −> ecommenda ion
by a doc o −> ehabili a ion p og amme −> aised awa eness −> inc eased
sel -me cy and asse i eness −> men al shi −> e-o de ing o
p io i ies −> ull eco e y
Emo ional one: happy and elie ed
Explana o y: own pe ec ionism
Mo ally blamed: eeling o insufficiency
Mo ally p aised: ehabili a ion and husband’s eco e y
E hically good: e-o de ing o p io i ies in li e and being econnec ed o he amily
E hically bad: –
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
6
imp o ing be ween he wo pe iods o he p og amme h ough an ac-
cumula ion o posi i e e en s (imp o emen in husband’s heal h, no -
maliza ion o wo king hou s, ime spen wi h g andchild en) and pe -
sonal agency (spo s, con e sa ions a home abou he spouse’s disease,
changes in nu i ion). The wo k en i onmen and he hi ing o an ex a
pe son allowed o a mo e long- e m planning and o ecas ing, which in
u n exe ed a beneficial effec on As id’s well-being. She also a ib-
u ed he commencemen o eco e y o he pee suppo ecei ed om
he ehabili a ion g oup, which ein o ced he p oxy agency. A sig-
nifican men al shi was disce nible in he accoun :
“When I came he e i el like being in a unnel, wi h no ligh a he end o
i . The walls we e alling in. Bu now I see so many o he possibili ies,
ha wo k is no always he only igh hing o do, ha he e a e o he
hings you can spend you ime on. I don’ know, I don’ unde s and i I
was eally so bu n ou ha I didn’ see any hing else. Bu now my mind
has begun o clea in a o ally diffe en way”
As id’s well-being was main ained a e he ehabili a ion p o-
g amme and was de ec able al eady a he second ime-poin . This was
also confi med by he BBI-15 measu emen sco e, which showed no
p esence o bu nou . The hi d sub-na a i e was asse i e, imbued wi h
posi i e emo ion, sel -confidence, dedica ion and commi men o wo k.
Wo k was pe cei ed as manageable and enjoyable, and As id’s lea-
de ship was isible in decision-making, conflic esolu ion and he
handling o mino p oblems in he wo kplace. As id pe cei ed he sel
as ully eco e ed. The e is also a sense o elie , as he husband’s
suspec ed disease u ned ou no o be se ious. As he eco e y ad-
anced, As id pu enewed effo in o he hobbies, which u he ac-
cele a ed eco e y. As id’s pe sonal agency was high, and she a gued
ha eco e y s a s om onesel , bu she also exe cised p oxy agency
by elying on he occupa ional nu se’s ecommenda ions:
“Reco e y s a s om onesel ...I’ e lea n wo k he ha d way and also I
use he wo d le ing go and I ha e delega ed o he o he s...I ha e jus
lea n i and come o he ealisa ion ha i I don’ le go hen I won’ be
able o manage…and hen he e’s he occupa ional heal h nu se […]
who always eminds me o my well-being…so his is also a means o
help”
She concluded he na a i e in a sligh ly humo ous way, which
condensed he meaning o he ans o ma ion she had unde gone:
“When I u ned 60 I said in my hank you speech ha he hea e has
been my second home and my husband co ec ed me saying ha i was
he fi s (laugh e )…and hen I ponde ed o he fi s ime whe he e -
e y hing is in he igh o de (laugh e ), ha indeed i has been like
ha ...I don’ know i i ’s inhe i ed om home, bu wo k has always been
numbe one…and i has been ex emely difficul o change his, bu I
hink I ha e succeeded in i .”
As id’s na a i e demons a es he powe o p oxy agency e-
p esen ed by he doc o , who sugges ed aking a dis ance om wo k,
and he occupa ional heal h nu se, who suppo ed he a a la e s age.
As id was able o a ail he sel ully o he lessons lea n in e-
habili a ion. He na a i e, desc ibing he aised awa eness, men al
shi and a changed a i ude owa ds he sel and wo k also shows he
s eng hening o he al eady exis ing pe sonal agency. He mo i a ion
o manage a wo k un il e i emen was high, bu his was handled in a
balanced way, allowing o he inco po a ion o o he meaning ul and
impo an aspec s o li e such as he amily, social engagemen s and
spo s ac i i ies.
The na a i e is comple e, and i s emo ional one is one o happiness
and elie . He eco e y, commenced wo yea s ea lie , con inued on a
s able pa h, along wi h a ealignmen o he alues and p io i ies in li e.
The explana ion o bu nou was ound in onesel : As id’s pe ec-
ionism and inabili y o delega e du ies is pe cei ed as he main eason
o he bu nou . She blames he own eeling o inadequacy and he
desi e o main ain con ol o e e e y hing, whe eas she exp esses he
g a i ude o he ehabili a ion p o essionals and o he posi i e e en s
ela ed o a amily membe ’s heal h. On he e hical le el, As id did no
iden i y any hing as “e il”, bu ins ead celeb a ed he e-o de ing o he
p io i ies in li e and he e-eme gence o connec edness wi h he amily.
3.5. Common hemes
Acco ding o Riessman (2004, 2008), hema ic na a i e analysis
enables common hema ic elemen s o be acked ac oss pa icipan s’
accoun s while a he same ime p ese ing he s o y as an en i y.
Following Riessman’s guidelines (2008), we iden ified h ee common
hemes ha we e encoun e ed ac oss he na a i es and which we e
pa icula ly meaning ul o all ou pa icipan s.
3.5.1. The benefi s o he ehabili a ion cou se
The e was common ag eemen ha he ehabili a ion cou se was
c ucial o he eco e y p ocess. The cou se was ega ded by all pa i-
cipan s as highly beneficial and awa eness- aising. The suppo and
affi ma ion gi en by he ehabili a ion g oup alida ed he expe iences
each pa icipan had indi idually gone h ough. The knowledge and
p ac ical ad ice p o ided by he ehabili a ion p o essionals, along wi h
hei non-judgmen al a i ude, helped pa icipan s a icula e and com-
p ehend hei bu nou si ua ion and achie e bodily and men al
awa eness. Th ough ehabili a ion and he exe cise o p oxy ( ia he
p o essionals) and collec i e ( ia he g oup) agency, he pa icipan s’
pe sonal agency was e-ac i a ed and s eng hened, wi h i s effec s
ex ending well beyond he du a ion o he cou se. Rehabili a ion was
also an objec o he pa icipan s’sense-making p ocess and came in o
mo al p aise.
3.5.2. Supe iso suppo
Supe iso suppo was o immense impo ance o eco e y. An
unde s anding, empa hic supe iso was able o alle ia e he symp oms
o exhaus ion and acili a e he e-adap a ion o wo k by ensu ing
adequa e wo king condi ions and p o iding emo ional suppo . An
unsuppo i e o neglec ul supe iso , on he o he hand, ende ed
one’s pe sonal agency comple ely ineffec i e (in Diana and Sa a’s
cases), led o an inc ease in bu nou symp oms and he expe ience o
injus ice. Fu he mo e, such a supe iso could p ecipi a e a change o
job (as in Paula and Sa a’s na a i es).
3.5.3. Pe sonal ac o s
Pe sonal ac o s such as di o ce, he sickness o a close amily
membe o o onesel had a subs an ial impac on bo h he onse o
bu nou subsequen eco e y om bu nou . The simul aneous p esence
o a disease p e en ed o obs uc ed he pa icipan s om egis e ing o
dis inguishing he onse o bu nou . The ea and anxie y as well as
physical ailmen s caused by he disease in ques ion led in gene al o a
dec ease in pe sonal esou ces and an inc ease in epo ed symp oms o
exhaus ion and impai ed wo k capaci y, as seen in Paula’s and Diana’s
s o ies. C ises such as di o ce slowed down ecupe a ion, as demon-
s a ed in Sa a’s na a i e. The suspicion o a majo disease in he
pa icipan ’s pa ne , as in As id’s case, had a simila effec , causing he
pa icipan o expe ience an eno mous emo ional bu den on while he
emo al o ha h ea had an immedia e posi i e impac on he pa i-
cipan ’s well-being.
4. Discussion
The p esen s udy in es iga ed he na a i es o ou pa icipan s
co e ing he onse o bu nou and eco e y he e om o e he cou se o
wo yea s. The esul s demons a ed ha eco e y om bu nou is a
slow and indi idual p ocess, which does no ollow a uni o m pa h.
The mos c ucial ac o s o eco e y in his pa icula sample we e
agency, pa icipa ion in he ehabili a ion cou se and he supe iso
suppo . Agency bea s a esemblance o aking con ol o one’s li e,
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
7
being in cha ge and assuming esponsibili y, and s udies ha e shown
ha i plays a significan ole in ehabili a ion (Jä ikoski e al., 2013;
Salminen e al., 2015). Agency is a obus p edic o o well-being and
adap i e psychological unc ioning ac oss ime (Gallaghe , 2012),
which emphasizes u he he long- e m effec s o a s eng hened sense
o agency. Cong uen wi h his finding, ehabili a ion was ins umen al
in ein o cing pe sonal agency h ough p oxy and collec i e agency
wi h a ela i ely long- e m impac . Con e sely, he phase o bu nou
was associa ed wi h ineffec i e pe sonal agency and he absence o
o he modes o agency. I is no ewo hy ha e en in he na a i es o
in e up ed eco e y and inc eased bu nou pe sonal agency emained
p esen , al hough o a lesse deg ee han in he na a i es o s able
eco e y. The combina ion o high pe sonal agency wi h a suppo i e
job en i onmen and conduci e pe sonal ac o s p o ided he mos
a ou able p e equisi es o beneficial eco e y.
The ehabili a ion cou se was pe cei ed by all pa icipan s as ha ing
had an eno mous posi i e effec on hei eco e y. I p o ided nu-
me ous healing expe iences, affi ma ion and aluable knowledge in-
s umen al o he ea ly ecogni ion o bu nou symp oms.
Rehabili a ion in e en ions ha e been ecognized as means o he
alida ion and affi ma ion one’s expe iences o bu nou in p e ious
esea ch, al hough he o e all benefi has a ied depending on he
s uc u e and con en o he in e en ion (Salminen e al., 2015;
Fjellman-Wiklund e al., 2010;Söde be g, Jumisko, & Ga d, 2004).
Supe iso suppo o he lack he eo had a huge impac on he ease
o making he e u n o wo k and was an essen ial ac o influencing
pa icipan s’pe cep ion o s ess. A suppo i e manage had a posi i e
impac on well-being by alle ia ing he symp oms o exhaus ion and
helping he eco e ing employee e-adap o wo k. This ela ionship has
been demons a ed in o he s udies as well: Aas and colleagues (Aas,
Ellingsen, Lindøe, & Mölle , 2008) showed ha ce ain leade ship
quali ies, e.g., he abili y o make con ac , being unde s anding, being
empa hic, acili a e he e u n o wo k a e sick lea e whe eas lack o
suppo leads o an inc ease in he equency o sick lea e (Vaananen
e al., 2003).
The na a i es p esen ed he e we e highly indi idual and he e o-
geneous, which bea s es imony o he ac ha bu nou is a mul iplex
phenomenon as confi med by o he s udies (Ru he o d & Oda, 2014).
Pa icipan s we e able o oice hei unde s anding o he pa h hey had
walked and a ibu e pa icula meanings o he e en s and expe iences
encoun e ed. As expec ed, he e we e also ce ain simila i ies and
common ea u es, pa icula ly in he phase p eceding he onse o
bu nou , e.g., hea y esponsibili ies, bodily mani es a ions, a igue and
ul ima ely b eakdown, which ha e been epo ed in o he s udies as
well (Eks ed & Fage be g, 2005). The eco e y phase mani es ed mo e
a ia ion as he pa icipan s adop ed pa ially di e gen s a egies (e.g.,
change o job s. no change; agen ic e sus passi e/ ecep i e app oach)
and we e affec ed by ac o s beyond hei con ol, e.g., ad e se changes
in he wo kplace and a i ude o supe iso . The na a i es p esen ed
he e demons a e ha a change o wo kplace pe se was no a decisi e
ac o ei he con ibu ing o o impeding healing, as ound in p e ious
esea ch (Be nie , 1998). A significan ac o was he amoun o change
in impo an a eas such as supe iso suppo , and he possibili y o
influence one’s wo kload and implemen changes aimed a diminishing
wo k s ess. Pe sonal ac o s such as de e io a ion in one’s own o
pa ne ’s heal h, o dis up ion in he amily (di o ce o dea h o a close
ela i e) also played a majo ole in he exace ba ion o bu nou and
impeded he pa h o eco e y. This demons a es ha bu nou does no
occu in isola ion om o he li e e en s, bu in pa allel wi h hem,
which in u n p esen s he isk o bu nou emaining un ecognized.
Fu he mo e, eco e y may be slowed by hese pe sonal ac o s e en
when he necessa y changes a e implemen ed in he wo kplace.
4.1. Me hodological conside a ions
To inc ease he alidi y and eliabili y o he findings, we applied
diffe en ypes o iangula ion. T iangula ion be ween me hods was
implemen ed by collec ing da a om semi-s uc u ed in e iews and
sel - epo da a (i.e., BBI-15, Nää änen, 2003) a he fi s and second
da a collec ion poin s). Resea che iangula ion was also employed.
The fi s in e iews in 2012 we e conduc ed by h ee independen in-
e iewe s who we e no in ol ed in he ehabili a ion cou se and hus
p o ided a neu al pe spec i e. The in e iews a wo yea s pos e-
habili a ion we e conduc ed and ansc ibed by he second au ho . The
hi d au ho , who is a clinical psychology esea che , p o ided
knowledge o and p ac ical guidance on he applica ion o quali a i e
me hods. The ou h au ho , who is a physician and an expe in
bu nou , p o ided access o he ehabili a ion cou se and pa icipan s
and ensu ed a smoo h da a collec ion. The las au ho and he p ojec
leade , who is an expe ienced wo k and o ganiza ional psychologis as
well as an occupa ional heal h esea che , p o ided expe ise on he
heo e ical backg ound and da a analysis.
All he in e iews we e audio aped and ansc ibed e ba im o
ensu e maximum da a comple eness. The filled-ou ques ionnai es we e
s o ed in acco dance wi h he e hical guidelines o a chi ing in Finland,
and he BBI-15 sco es we e calcula ed by he fi s au ho o de e mine
pa icipan s’bu nou ca ego y a he second collec ion poin .
Pu pose ul sampling (Pa on, 2015) was applied in he s udy as we
wan ed o explo e he effec o job change on subsequen eco e y.
Semi-s uc u ed in e iews we e ega ded as a sui able me hod o
cap u ing he expe iences o pa icipan s, and he use o a ques ionnai e
con aining bo h s uc u ed and open ques ions was seen as an ap ool
o epo ing in e im s a us. The use o na a i e me hods o analysis
was jus ified due o he size o he sample and he longi udinal na u e o
he da a. The use o na a i es allowed a mo e in eg a ed in e p e a ion
o he expe iences epo ed by he pa icipan s (Bell, 2002) and a ocus
on he o e all oad om bu nou o eco e y o epea ed bu nou .
T acking he p ocess o eco e y o e ime offe ed a unique oppo uni y
o unco e indi idual pa hs and sense-making p ocesses.
The p esen s udy has na u ally ce ain limi a ions. Fi s , as i was
he ou come o pu pose ul sampling, he size o he sample was e y
small (Pa on, 2015). A la ge numbe o s udied pa icipan s could
e eal u he common hemes and demons a e in g ea e dep h he
impac on eco e y o changing s. no changing one’s job. Ad-
di ionally, all he pa icipan s we e emale and hus u he s udies wi h
mixed samples a e needed o alida e he esul s ac oss gende . How-
e e , he s udy pa icipan s we e ep esen a i e o he popula ion y-
pically a ending such cou ses (Hä inen e al., 2009, 2007, 2013). The
esul s canno be gene alized beyond he s udy pa icipan s owing o
he size o he sample and he ac ha pa icipan selec ion was based
on a dec ease in bu nou symp oms. On he o he hand, such gene al-
iza ions a e also beyond he scope and pu pose o quali a i e s udies. As
his is he fi s s udy in es iga ing long- e m eco e y om bu nou by
applying a na a i e app oach, i should be emphasized ha he ou -
comes o he analysis may eflec cha ac e is ics o he bu nou and
eco e y p ocesses specific only o hese ou pa icipan s.
4.2. Conclusions
In all, he na a i es demons a ed ha he p ocess and he deg ee
o eco e y om bu nou a y, as a mul i ude o ac o s –indi idual
effo , ehabili a ion, change o wo kplace, and supe iso suppo –
shape and modi y he pa h each indi idual akes. The mos a ou able
pa h o eco e y appea ed o be ac i a ed when pe sonal agency was
s ong and o he li e a eas –job en i onmen , supe iso , and amily
membe s –we e conduci e o eco e y. I should be ecognised, how-
e e , ha he ele ance o agency may be o e emphasized as he s udy
pa icipan s we e ini ially selec ed on he basis o success ul eco e y,
e en i pu pose ul sampling, using he c i e ia o deg ee o eco e y and
job change, was applied a he las da a collec ion poin . Al hough he
aim o he s udy was no o e alua e he effec i eness o he e-
habili a ion cou se, i is no ewo hy ha he cou se was essen ial bo h
S. Salminen e al. Bu nou Resea ch 7 (2017) 1–9
8
in equipping he s udy pa icipan s wi h he ools o ecognize and deal
wi h bu nou and in s eng hening all h ee modes o agency, and hus
i s inclusion in bu nou ea men should be conside ed. Fu u e s udies
should aim a deepening he exis ing knowledge on he ela ionships
be ween agency, job en i onmen and long- e m eco e y in a la ge
and mo e di e se da ase , p e e ably including amily membe s’sub-
jec i e expe iences o he en i e p ocess.
Conflic o in e es
The au ho s decla e ha he e a e no conflic s o in e es .
Acknowledgmen
The s udy was unded by a g an o S ela Salminen om he
Uni e si y o Jy äskylä.
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