Corporate / scarcity ideologies align with a harm reduction philosophy and policy since the former can affect the latter. These ideologies imply the creation and maintenance of specific ideas, vision, mission, and goals that are to be achieved in medical institutions, especially those paying precise attention to substance abuse prevention and decreasing the treatment with a biomedical model. Móró and Rácz (2013) assume that the mentioned ideologies may be utilized to create an appropriate treatment environment promoted through vision and corporate objectives. Such an approach is likely to assist nurses in understanding what exactly is required to ensure the most effective patient care associated with harm reduction.
Addressing social determinants of health may be regarded as harm reduction since this initiative also focuses on the context of drug use. Pauly, Reist, Belle-Isle, and Schactman (2013) emphasize that poverty, homelessness, and other social determinants that impact a person’s decision to use substances are targeted by health care as an attempt to eliminate them in terms of social justice. The promotion of equality in health care services expressed in inequality-responsive care is one of the methods of combating substance abuse.
In my practice, I encountered such ethical tension as distrust of patients to harm reduction model that was associated with stigma. Specifically, young adult patients revealed a mismatch between their expectations, needs, and the very logic of the “fixing” method (Lago, Peter, & Bógus, 2017). Therefore, if I were a policymaker, I would propose the creation of specific regulations declaring the necessity of increasing awareness among young people, nurse practitioners, and society as a whole. This initiative would decrease mistrust in people and lead to more effective harm reduction.
Burnout Types
Of three burnout types such as emotional exhaustion, personal accomplishment, and depersonalization, I experience emotional exhaustion. Leiter and Laschinger (2006) argue that emotional exhaustion occurs when there is a lack of nurse support, cooperation in an organization, or insufficient responsiveness from management. As a Registered Nurse working in acute care settings, I have to encounter patients in various severe conditions, the treatment of which requires many mental and physical efforts that are the key causes of my emotional exhaustion. In my point of view, my busy schedule does not satisfy my workplace expectations and cause stress and negative emotions that gradually accumulate and lead to emotional burnout. In other words, such a condition may be considered a type of psychological defense mechanism for tension.
To increasing the value of nursing work, nurses may report their burnout cases to leaders and managers, so that they may advocate for adjusted regulations and new initiatives aimed at preventing and eliminating burnout. More to the point, they can discuss their problems collectively during meetings and training sessions to resolve the issue in collaboration with each other. The interaction with policymakers and representatives of both local and national organizations is another way to improve the current situation. Specifically to my workplace, I assume that the creation of a welcoming working environment may be proposed. Consistent with Van Bogaert, Kowalski, Weeks, and Clarke (2013), I suggest that the involvement in the decision-making process along with daily tracking of work outcomes may be applied as a means of designing a trusting atmosphere among nurses. Besides, interdisciplinary teamwork initiatives may be applied towards various specialists, thus providing the opportunity to treat patients consistently and avoid misunderstanding between them.
References
Lago, R. R., Peter, E., & Bógus, C. M. (2017). Harm reduction and tensions in trust and distrust in a mental health service: A qualitative approach. Substance Abuse Treatment, Prevention, and Policy, 12(1), 12-21.
Leiter, M. P., & Laschinger, H. K. S. (2006). Relationships of work and practice environment to professional burnout: Testing a causal model. Nursing Research, 55(2), 137-146.
Móró, L., & Rácz, J. (2013). Online drug user-led harm reduction in Hungary: A review of “Daath”. Harm Reduction Journal, 10(1), 18-27.
Pauly, B. B., Reist, D., Belle-Isle, L., & Schactman, C. (2013). Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy, 24(4), 284-290.
Van Bogaert, P., Kowalski, C., Weeks, S. M., & Clarke, S. P. (2013). The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey. International Journal of Nursing Studies, 50(12), 1667-1677.
Nurse staffing is one of the most burning issues in the American healthcare system. Burnout and low job satisfaction are central factors contributing to the high turnover among nursing practitioners especially when it comes to intensive care units (ICU). The purpose of this study is to evaluate the effectiveness of the intervention aimed at reducing burnout and increase ICU nurses’ job satisfaction. The intervention implies the use of expressive writing as a tool to develop resilience necessary to recover from burnout. 100 ICU nurses from local healthcare facilities will be recruited. The dependent variables will be the level of satisfaction and burnout. The independent variables will be nurses’ age, educational background, and working experience. The participants will be randomly divided into the control and experimental groups. The experimental group will write reflections (that will take 10-30 minutes) using the provided prompts on a weekly basis. The intervention will last 3 months. Before the start of the intervention and upon its completion the participants from the two groups will complete the job satisfaction scale, Maslach Burnout Inventory–Human Service. The experimental group will also complete brief surveys on the intervention. This survey will help in improving the intervention under analysis. SPSS will be used to analyze the obtained data.
Introduction
Problem & Significance
The lack of nurses is one of the most burning issues that have to be addressed within a short period of time due to the growing population of aging patients. Nursing practice is associated with various challenges many people are unprepared and unwilling to face. Burnout and associated low job-satisfaction are some of the most influential factors resulting in high turnover rate among nursing practitioners working in intensive care units (ICU) (Mealer, Shelton, Berg, Rothbaum, & Moss, 2007). Van Mol, Kompanje, Benoit, Bakker, and Nijkamp (2015) note that the prevalence of burnout among ICU nurses often reaches 70%. Certain interventions have been developed to address the problem. Some programs concentrate on the physical activity, while others imply the focus on psychological assistance to nurses, but the issues still persist (Mealer et al., 2017). The purpose of the proposed intervention is to evaluate the effectiveness of expressive writing as a tool decreasing ICU nurses’ burnout and increasing their job satisfaction. The project will potentially improve the working environment in the clinical setting.
The major concepts employed are burnout and expressive writing. Moss, Good, Gozal, Kleinpell, and Sesler (2016) note that burnout is associated with the imbalance of nurses’ personal traits and organizational factors. The factors contributing to nurses’ burnout include excessive workload, unfavorable working environment, and the like (Myhren, Ekeberg, & Stokland, 2013). The outcomes associated with burnout include depressive symptoms, irritability, emotional exhaustion, sleeping or eating disorders and so forth.
The present study will also have a theoretical significance as it will be associated with the development of an intervention and its evaluation. The evaluation instruments that will be utilized will be surveys exploring the participants’ degree of burnout, job satisfaction as well as perspectives concerning the intervention. Similar tools can be applied when implementing and evaluating similar projects.
Research Objectives
The objective of the present research is to evaluate the efficacy of an intervention aimed at decreasing nurses’ burnout and increasing their job satisfaction. Prior to identifying the research question, it is necessary to formulate the PICO question guiding this study. The PICO question is as follows: Among ICU nurses (P), does the participation in the expressive-writing-based intervention (I), as compared to no intervention (C), decrease burnout and increase job satisfaction? Therefore, the research question can be formulated in the following way:
Does ICU nurses’ participation in the expressive-writing-based intervention, as compared to no intervention, decrease burnout and increase job satisfaction?
The independent variables employed for the purposes of the proposed study are nursing professionals’ age, working experience, and educational background. Working experience is one of the most important variables as it has a direct effect on burnout. The longer nurses are exposed to certain challenges, the higher level of burnout and the lower level of job satisfaction they will have. The participants’ educational background and age can be influential factors affecting the way they feel about the intervention and their engagement (Mealer et al., 2017). The dependent variables are the level of burnout and job satisfaction. The research hypothesis is as follows:
H1: The level of burnout of ICU nurses’ participating in the proposed intervention will decrease, and their level of job satisfaction will increase.
H2: The level of burnout of ICU nurses’ who will not participate in the proposed intervention will not decrease, and their level of job satisfaction will not increase.
Background /Literature Review
Burnout is a common challenge nursing professionals face, so it has been well-researched. It has been acknowledged that this problem is closely related to high turnover rate (Genly, 2016). Job satisfaction has also acquired sufficient attention in the academia as it is one of the most influential factors affecting nurses’ performance and their overall well-being (Myhren et al., 2013). The major predictors of the increase in burnout levels and low job satisfaction are an unfavorable working environment, excessive workload, a high level of responsibility, exposure to stressful situations, and so forth (Epp, 2012). Ntantanaa et al. (2017) found that personality traits also have an effect on nurses’ job satisfaction and their burnout. At the same time, peers’ or managerial support has proved to correlate negatively with burnout levels and have a positive impact on nurses’ overall well-being and their job satisfaction (Hunsaker, Chen, Maughan, & Heaston, 2015; Khamisa, Peltzer, Ilic, & Oldenburg, 2016). Therefore, the primary factors associated with high burnout level and low job satisfaction in ICU nurses are known and described in detail.
The development and evaluation of interventions aimed at addressing the issues under analysis have been extensively researched. For instance, mindfulness practices and resilience are regarded as effective strategies to cope with burnout (Rushton, Batcheller, Schroeder, & Donohue, 2015). Mealer et al. (2017) found the effectiveness of resilience development and mindfulness practices implementation. The researchers evaluated the effectiveness of an intervention aimed at decreasing burnout among nursing practitioners. The intervention consisted of three components including physical activity, mindfulness practice, and expressive writing. However, the researchers also pointed at a limitation of their study as it was difficult to estimate the efficacy of each component of the intervention. There is certain research in this area as Evans, Mealer, Jooste, and Moss (2015) carried out a pilot study that evaluated the effectiveness of an expressive-writing-based program. Evans et al. (2015) note that the participants pointed at some weaknesses of the program, such as its focus on nurses’ general knowledge rather than ICU-specific experiences. Therefore, it can be beneficial to concentrate on expressive writing based on ICU experiences as a strategy to cope with burnout and improve ICU nurses’ job satisfaction.
Theoretical Framework
The focus of the projects is the evaluation of the effectiveness of a program aimed at building ICU nurses’ resilience that can help them cope with burnout and improve their job satisfaction. Polk’s four-dimensional model of resilience will be used as the theoretical framework for the present study (Haase & Phillips, 2016). Polk stresses that such dimensions as dispositional, relational, philosophical, and situational are critical when building resilience. The proposed program will include prompts developed on the basis of this approach that embraces such domains as physical, philosophical, social, and situational.
Protection of Human Subjects
The proposal will be submitted for IRB approval in order to ensure the adherence to the highest ethical norms in research. One of the most sensitive issues related to ethical aspects is participants’ confidentiality (Grove, Burns, & Gray, 2014). This project is associated with nurses’ reflection on rather traumatic experiences that require a certain degree of sincerity and commitment to the study’s goals. The participants will sign informed consent forms where they will be informed about the ways their data will be secured (see Appendix). Their names will be coded while their writings will be stored for a brief amount of time. The participants will also be informed about their ability to withdraw from the research at any point as well as their right to be assigned to the experimental group if necessary.
Methods
Research Design
Quasi-experimental design is chosen for the proposed study. The ICU nurses of several local healthcare facilities will take part in the research. The validity of the sample is compromised as it is unlikely to represent the entire population of ICU nurses. Nevertheless, the study will provide insights into the strengths and weakness of the proposed intervention, which makes it relevant.
Inclusion criteria
The inclusion criterion will be nurses’ working experience, or rather the years spent in the ICU setting.
Exclusion criteria
The exclusion criterion will be the recruited people’s participation in similar interventions that used expressive writing as an instrument to address burnout.
Sampling Plan
The overall number of participants will be 100. Once the required number of participants is reached, the recruitment process will stop. Convenience sampling will be utilized since all ICU nurses working for several healthcare facilities will be recruited. At that, they will be able to refuse to take part or withdraw from the study. The recruitment process will involve the close collaboration with the facilities’ administration that will encourage their employees to participate.
Intervention
The modified project evaluated by Evans et al. (2015) will be used. The intervention will include a workshop at the beginning of the program. Nurses will write brief reflection papers on a weekly basis. The writing will last for 10-30 minutes during which the participants will respond to a prompt. The overall duration of the intervention will be three months. On the completion of the program, the nurses who will take part in the project will complete short reports on the intervention.
Data Collection Methods
The participants of this study will be randomly divided into a control and experimental group. The former will not receive the intervention while the latter will be asked not to reveal the details of their writing. Pretest-posttest design will be employed to answer the research questions mentioned above. The level of burnout and job satisfaction of the participants will be measured before and after the implementation of the intervention.
Instruments/Measurements
In order to measure the participants’ burnout Maslach Burnout Inventory–Human Service (Rushton et al., 2015). The level of job satisfaction will be measured with the help of the job satisfaction scale (10-70) (Myhren et al., 2013). These tools will be provided to the participants through their facilities’ information systems. In addition, the participants in the experimental groups will complete a brief (3-question) survey on the weaknesses and strength of the intervention. The validity of the data can be ensured through the use of two variables that are closely connected. It can be expected that the participants who have a high level of burnout will be characterized by a low level of job satisfaction. Cronbach’s α will be utilized to check data reliability. The operational definitions can be formulated as follows:
Job satisfaction
Job satisfaction level will be the score the participants will get when completing the job satisfaction scale.
Burnout
The level of burnout will be the score the participants will get when completing Maslach Burnout Inventory–Human Service.
Intervention effectiveness
The effectiveness of the intervention will be measured with the help of the participants level of burnout and job satisfaction. The lower these levels are after the project completion, the more effective the intervention is.
Data Analysis
Descriptive statistics will be employed when analyzing the collected data. SPSS is one of the common statistical software. This instrument will be used to analyze the findings.
References
Epp, K. (2012). Burnout in critical care nurses: A literature review. Dynamics, 23(4), 25-31.
Evans, J. F., Mealer, M., Jooste, K., & Moss, M. (2015). Expressive writing for caregiver resilience. In K. Thompson & K. Adams (Eds.), Expressive writing: Counseling and healthcare (pp. 43-62). New York, NY: Rowman & Littlefield.
Genly, B. (2016). Safety & job burnout: Understanding complex contributing factors. Professional Safety; Des Plaines, 61(10), 45-49.
Grove, S. K., Burns, N., & Gray, J. (2014). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier Health Sciences.
Haase, J. E., & Phillips, C. R. (2016). Resilience. In S. J. Peterson & T. S. Bredow (Eds.), Middle range theories: Application to nursing research and practice (4th ed.) (pp. 259-278). Philadelphia, PA: LWW.
Hunsaker, S., Chen, H., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194.
Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B. (2016). Work related stress, burnout, job satisfaction and general health of nurses: A follow-up study. International Journal of Nursing Practice, 22(6), 538-545.
Mealer, M., Hodapp, R., Conrad, D., Dimidjian, S., Rothbaum, B., & Moss, M. (2017). Designing a resilience program for critical care nurses. AACN Advanced Critical Care, 28(4), 359-365.
Mealer, M., Shelton, A., Berg, B., Rothbaum, B., & Moss, M. (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine, 175(7), 693-697.
Moss, M., Good, V., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). An official critical care societies collaborative statement – Burnout syndrome in critical care healthcare professionals. CHEST, 150(1), 17-26.
Myhren, H., Ekeberg, Ø., & Stokland, O. (2013). Job satisfaction and burnout among intensive care unit nurses and physicians. Critical Care Research and Practice, 2013, 1-6.
Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., & Koulouras, V. (2017). Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational, multicenter, cross-sectional study. Intensive and Critical Care Nursing, 41, 11-17.
Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420.
Van Mol, M. M. C., Kompanje, E. J. O., Benoit, D. D., Bakker, J., & Nijkamp, M. D. (2015). The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. PLoS ONE, 10(8): 1-22.
Unfortunately, Garrosa, Rainho, Moreno-Jimenez and Monteiro (2010, p. 205-217), authors of “The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: A correlational study at two time points,” do not address the benefits and risks of participating in this study. On the other hand, these risks and benefits are noticeable. First, the confidentiality of the subjects’ information was not assured; thus, the information of these subjects could be revealed to a third party, and this could place the nurses at risk of job loss. Secondly, the patients were at risk of recurring emotional pain because they had to think about some past experiences such as death of a patient when filling out the questionnaire.
This study was also investigating coping mechanisms, and the authors should have told the subjects that they would benefit by learning about some of the effective coping strategies that would help them address their burnout. Despite the fact that there was no provision of informed consent, the subjects took part in the study willingly as indicated by the statement, “…and all of them agreed” (Garrosa et al., 2010. p. 207). There is no indication that the study was approved by an institutional review board.
The variables under study are succinctly identified, but not their categorization. The reader is left to delineate the independent and dependent variables. The dependent variable is burnout while the dependent variables are “job stressors, hardy personality and coping mechanisms at two different time points” (Garrosa et al., 2010. p. 205-215). Data was collected in the form of a questionnaire, and variables were quantified using scores. In addition, data was collected in two phases: first time and 4-weeks later.
The authors did not give a detailed description about the mode of study. But, judging by the nature of data collected, quantitative data was collected. The objective of the author was to find a correlation between the aforementioned independent variables and burnout, and there is no better method to achieve this other than by using a quantitative approach. The authors state that the research design used: cross-sectional design, is imperative in this study because it ensured a temporal dimension that did not attribute the effects of variables to the methodological artefacts (Garrosa et al., 2010, p. 208). In addition, according to Burns and Grove (2011, p. 34), correlational analysis helps a researcher to obtain the degree and the nature of relationship between variables.
In accordance with the aim of this paper, interpretation of findings will solely focus on the job stressors. Socio-demographic characteristics did not have significant effects on burnout. Correlation (temporal effect) of variables was carried out in two steps: wave 1 and wave 2 (cross-sectional level). Commensurate with other studies, this study revealed a significant relationship between the job stressors and burnout at the correlational level.
The study emphasizes that emotional exhaustion and overload are reliable variables, and both have a strong correlation. I have no confidence in these findings due to inadequacies in the methodological procedure. First, as noted by Burns and Grove (2011, p. 40, 51), sample size determination is imperative, and it should be a reflection of the study population. Convenience sampling, used in this study, tends to introduce sampling bias because those recruited are subjectively selected, and the probability of recruiting every member of the larger population is not guaranteed.
The study is a cross-sectional study, in which data was collected at a certain point in time in two stages. However, it is not clear how much time was spent to collect data at each stage. The questionnaire was a self-evaluation of oneself in reference to the variables. Each participant filled out a burnout questionnaire.
There is no indication of the statistical software used for data analysis. However, various tests were applied to reassure the rigor of the methodology. Normality was checked for all indicators, and linear regression analysis was used to test the hypotheses. In addition, multicollinearity of data was evaluated. The authors have mentioned their critical decision to separate variables in stages (3 stages) while simultaneously checking for correlation. This stepwise approach was used to reduce bias attributed to common method (cross-section research design). There is no indication of the number of researchers who analyzed the data; hence, it is not certain that researcher bias was addressed.
Findings were presented in a coherent manner, and each variable was discussed at a time. The methodology was highlighted as one limitation of this study. Secondly, the sample size used was small and targeted an unspecified cohort as indicated by the demographic characteristics, making it difficult to generalize results. Also, the short time interval between the two points in time was a limitation. Future studies should address the raised concerns by recruiting a larger sample size, adopting an experimental approach, and increasing the interval between the two points in time.
This study indicated that there is a relationship between the studied variables, but in accordance with Burns and Grove (2011, p. 35), more credible methods such as the quasi-experimental and experimental studies are required. The study results cannot be generalized to a particular population because of the unknown characteristics of the study sample. The only clear and generalizable characteristic known is that the study was carried out in Portugal among the nurses, but the sample size is too small.
This study has implications for nursing practice as an entire unit, for example, identification of job stressors associated with burnout and how to deal with them. Drawing such findings for implication in the nursing field is supported by the fact that these findings are commensurate with a majority of other studies adopting a similar cross-sectional approach.
References
Burns, N., & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-Based Practice (5th ed.). Maryland: Elsevier Sanders.
Garrosa, E., Rainho, C., Moreno-Jimenes, B., & Monteiro, M. (2010). The relationship between job stressors, hardy personality, coping resources and burnout in a sample of nurses: A correlational study at two time points. International Journal of Nursing Studies, 47, 205-215.
Burnout syndrome is a psychological phenomenon identified by gradual emotional and physical fatigue, including the occurrence of adverse perceptions and attitudes towards work and a decrease in empathic concern towards patients (Alharbi, 2019). It arises due to continuous straining, usually caused by intensive, prolonged involvement with people (Dawood et al., 2017). The World Health Organization recently updated its definition of burnout to a syndrome that occurs as a result of prolonged occupational stress that that has not been properly managed. The following three cardinal symptoms stipulated by the WHO were as follows,
Feelings of exhaustion or energy depletion
Elevated mental detachment towards one’s job and career.
Reduction in professional productivity.
It is estimated that 21 to 61 percent of health care practitioners exhibit signs of burnout (Alharbi, 2019). This is due to the demanding nature of the profession. Factors such as caseload size, workplace climate, and severity of patient symptoms have increased burnout among nurses.
Background
Mental health cases occurrences have been on the rise over the past few decades around the globe and in Qassim city. This translates to an increased requirement of psychiatric nurses to work in health care facilities, such as Qassim psychiatric hospital. The consequential shortage of nurses leads to an increase in the workload each nurse is expected to execute. Psychiatric nurses are most prone to work-related stress since they are primarily in continuous, direct contact with patients (Alharbi, 2019). Their work is demanding and requires their full attention and service for long periods. These working conditions, staff shortage, fatigue, interpersonal conflicts, high work expectations, and lack of personal progress contribute to burnout syndrome.
Burnout adversely affects the efficiency of nurses in their practice. It is a critical issue that needs addressing since it causes severe impacts on nurses including, depression, sleep issues, physical and mental exhaustion, feelings of hate towards responsibilities, and anxiety (Alotni & Elgazzar, 2020). Patient care is also affected since burnout nurses’ ability to function is reduced. They develop memory issues, reduced attention to detail, impaired cognitive function, and vigilance (Gheshlagh et al., 2017). These nurses also lose their motivation to work and are often need to be supervised to perform their duties. There is a need to review the prevalence of burnout syndrome in psychiatric nurses to address this issue. There is, however, not enough researches done on this topic, and none has been done in Qassim city. This study, therefore, aims at establishing the prevalence of burnout among psychiatric nurses in Qassim psychiatric hospital.
Statement of Problem
Burnout syndrome among psychiatric nurses in Qassim city is a critical issue that needs to be addressed. To date, there exists an inadequate amount of studies concerning the prevalence of burnout in psychiatric nurses in Saudi Arabia, and no study was conducted in Qassim psychiatric hospital. Nurses who work in Qassim psychiatric hospital may have some challenges, which might contribute to increasing the level of burnout and then affect the workforce outcomes. Identifying the prevalence of burnout in Qassim psychiatric hospitals is likely to assist decision-makers and organizations in modifying policies and systems, which can help create a healthy work environment. This would also help improve the quality of nurses’ work and healthcare delivery. Therefore, the research would help organizations identify strategies to prevent or reduce burnout. In addition, it would also help organizations to identify the contributing factors of burnout and address them. The result of this research would assist in educating psychiatric nurses in Qassim psychiatric hospital about burnout syndrome.
Literature Review
The welfare of health care practitioners is an essential determinant of the quality of the health care services delivered. Burnout is one of the hindrances of the ability of nurses and medical practitioners, in general, to provide adequate services to health care users (Alotni & Elgazzar, 2020). The psychiatric nursing practice encompasses a considerable amount of psychological and psychosocial stressors. These stressors are responsible for burnout in these nurses compared to nurses in departments such as neonatal and peri-operative.
Many Arab countries have health care systems that are still developing and have not yet attained world-class medical equipment, finances, and government policy. Basic infrastructure, such as transport, communication, and health care facilities to expedite the provision of health care services is also lacking (Noureen et al., 2019). In Saudi Arabia, for instance, most hospitals, including Qassim psychiatric hospitals, record inadequate room in wards to accommodate all admitted patients. Despite a fairly adequate number of qualified nurses in the country and foreign nurses, many local hospitals are understaffed (Alotni & Elgazzar, 2020). The ratio of nurses to patients seeking service in Qassim psychiatric hospital is unproportioned, with nurses required to attend to significantly more patients in a day compared to developed countries (Gheshlagh et al., 2017). This ratio proves the theory that nurses are understaffed and overworked.
Overworking leads to negative physical and psychological ramifications, including depression, crucial family issues, diminished occupational satisfaction, lowered performance, chronic absenteeism, and eventually quitting of work. Burnout has also been attributed to deteriorating medical professionals’ physical health, causing anxiety, cardiovascular disorders, loss of motivation, physical fatigue, and depression (Noureen et al., 2019). The health system organization is also interrupted by interpersonal conflicts among health care workers caused by burnout. Psychiatric and intensive care units are the two departments most affected by burnout (Gheshlagh et al., 2017). These sectors demand a high level of involvement of nurses in attending to patients. Nurses, being the forefront, and most immediate responders, are tasked with providing care to these patients who often require prolonged and constant monitoring.
Search strategy
A systematic search evaluated studies published within the last five years using PubMed, Google Scholar, and PsycINFO databases. The keywords used during the search were “burnout syndrome,” and “psychiatric nurses,” and “psychiatric hospitals.” The total number of studies obtained from the first round of the search was 3,510. From these articles, those not published in English were excluded from the search, while those published in English were included. The articles written in English were then evaluated using their titles, abstracts, and full text. The search then excluded those studies that focus primarily on psychiatric nurses. Since burnout syndrome is a work associated disease, the search also excluded the theories that focused solely on personal factors such as age and gender. With the exclusion and inclusion criteria, six studies were ultimately identified.
Categories of Burnout
Burnout can be categorized into three variations including,
Emotional exhaustion (EE) – overstretch of emotional expression leading to strain in personal and professional life.
Depersonalization (DP) – a reduced sense of personal and professional accomplishments.
Personal accomplishment (PA) – inability to sustain work and diminished self-motivation.
The Quality of Existing Literature and Research Gap
Previous research has covered chiefly burnout’s causes, risk factors, and effects on healthcare practitioners. Studies carried out in England, Germany, Scotland, Canada, and the United States have lightly explored the prevalence of burnout syndrome in healthcare professionals (Zaki, 2016). In Saudi Arabia, research was carried out in a public psychiatric health facility in Dammam. The facility has wards with a capacity of up to 500 beds and about 1000 nurses (Alotni & Elgazzar, 2020). The study reported higher levels of burnout mainly among older, married nurses as opposed to single, younger nurses. There is, however, an apparent need to conduct further research on burnout syndrome in Saudi Arabia. This study, therefore, will aim at establishing the prevalence of burnout syndrome among nurses working in Qassim psychiatric hospital. The study will add details missing in previous research and add more data to facilitate solving the existing burnout problems and ultimately improve healthcare service quality in Saudi Arabia.
Conceptual Framework
Burnout depends on psychiatric nurses’ knowledge and their perspective towards work. Demographic details such as, place of work, marital status, sex, age, work experience, qualification, and level of education determines nurses’ vulnerability to burnout syndrome (Gheshlagh et al., 2017). Characteristics of work, including, work resources and demands also contribute to the probability of burnout in psychiatric nurses. This concept and variables are represented in the diagram depicted below.
Figure 1. Conceptual framework showing the relationship between professional burnout and knowledge and work perception. Adapted from Zaki, R., 2016, Job stress and self-efficacy among psychiatric nursing working in mental health hospitals at Cairo, Egypt. Journal of Education and Practice, 7(20), p.110.
Methodology
Aim of the Study
The study will aim at determining the prevalence of burnout syndrome among nurses working in Qassim psychiatric hospital.
Objectives of the Study
The objectives of the study include,
To establish the causative demographic factors of burnout
To establish the risk factors of burnout
To advice policy making on the best ways to avoid burnout in nurses
To determine the level of burnout syndrome in nurses in Qassim psychiatric hospital
Philosophical Stance
The study will be evaluating the level of burnout in psychiatric nurses in Qassim city. Demographic data and work-related factors significantly affect the prevalence of burnout syndrome. A cross-sectional research is suitable since it gives the participants a platform to describe how they feel concerning burnout.
Research Design
Once approved, this research will apply the use of a cross-sectional study design. This research design has great descriptive capabilities that enable it to effectively assess the feelings of nurses involved in the study. This design is suitable for the projected sample size and promises the most viable data. This study uses questionnaires to collect data, a cross-sectional research design will be effective in systematically obtaining information
Study Population
The study will target registered nurses with a minimum of one year of working in Qassim psychiatry hospital.
Exclusion Criteria
Nurses who have less than a year of experience or those that decline to participate will be excluded from the study.
Sample
The study targets an estimation of about 200 registered nurses. This is a good percentage of the total number of nurses working in the facility. This sample size can therefore represent the entire target population.
Sampling Technique
The research will use the simple random sampling technique to select participants. This method is orderly, effective, and eradicates bias, thus ensuring a representative sample of the target population. This technique was also used on other reviewed articles and provided viable results.
Research Instruments
The study will employ questionnaires and to obtain data from the participants. Relevant hospital records will also be consulted for information about the conduct of the nurses (this may include absenteeism, records of any conflicts, and history of nurses’ resignations). The Maslach Burnout Inventory (MBI) is also used and is validated by detailed studies for more than thirty five years. This tool will be translated to Arabic for easy comprehension of by the participants.
Ethical Issues
Through the ministry of health, the government will approve the research and the proposed methodology before commencing. The rules and regulations of the Arabian government will also be considered. The research procedure will be presented for approval to the hospital’s ethical review committee and the university board of directors, as well as the instructor. A printed and signed informed consent will also be a mandatory requirement for all the participants. Personal information obtained will be handled with privacy and confidentiality. This data will only be used for the analysis of the research findings.
Procedure
After approval and selection of the participants, the research questionnaires will be distributed among the nurses. The questionnaires will be filled and returned to the researcher. The questionnaires will consist of two sections, Maslach Burnout Inventory (MBI) to measure burnout, and, the participants’ demographic data. Demographic entries will include the occupation, nationality, gender, marital status, working hours and schedule, level of education, alcohol consumption and smoking status, and age. The second part will contain the Maslach burnout inventory (MBI) entries. It is a 22-component, self-reported tool designed to conduct a quantitative evaluation of various categories of BOS. All entities are graded on a five-point mark, 0 = never/no change, 1 = rarely, 2 = some times, 3 = often, and 4 = always/large change. The total of the entry answers are respectively grouped into: 27–37 = no burnout, 38–49 = mild burnout, 50–69 = moderate burnout, 70–89 = severe burnout, and >1 = very severe burnout. The Cronbach’s alpha for the Maslach burnout inventory is 0.80 with a variation of 0.79–0.81 for the subscales
Data Analysis
The obtained data will be synthesized using the statistical package for the social sciences (SPSS) software, version 24. (IBM Software, Chicago, USA). Descriptive statistics for the occupation, education level, marital status, gender, and age of the subjects were analyzed. The standard deviation and mean values for the MBI were evaluated for all the subjects. The relationships between sociodemographic and BOS variables were assessed by multi-nominal logistic regression analysis. Statistical significance was indicated by P < 0.05.
Work Plan
The study will be conducted and be ready for presentation over five months.
References
Alharbi, S. (2019). Occupational stress, coping strategies, and quality of life among nurses in general and psychiatric setting in Jeddah City—KSA. Open Journal of Psychiatry, 9(2), 124-137.
Alotni, M. A., & Elgazzar, S. E. (2020). Investigation of burnout, its associated factors, and its effect on the quality of life of critical care nurses working in Buraydah Central Hospital at Qassim Region, Saudi Arabia. The Open Nursing Journal, 14(1), 190-202.
Dawood, E., Mitsu, R., & Monica, A. (2017). Perceived psychiatric nurses job stress: A cross sectional study. IOSR Journal of Nursing and Health Science, 6(2), 37-47.
Gheshlagh, R., Parizad, N., Dalvand, S., Zarei, M., Farajzadeh, M., Karami, M., & Sayehmiri, K. (2017). The prevalence of job stress among nurses in Iran: A meta-analysis study. Nursing and Midwifery Studies, 6(4), 143-148.
Noureen, A., Shah, A. A., & Shah, M. A. (2019). The moderating role of coping strategies in occupational stress and burnout among mental health practitioners in Pakistan. Clinical and Counseling Psychology Review, 1(1), 28-43.
Zaki, R. (2016). Job stress and self-efficacy among psychiatric nursing working in mental health hospitals at Cairo, Egypt. Journal of Education and Practice, 7(20), 103-113.
Strategies to Cope With Burnout and Turnover in Nurses
It is no secret that nurses’ burnout and turnover are significant issues in nursing. According to Lockhart (2020), the number of nurses’ turnovers is expected to increase due to two leading negative factors, such as shift length and staff relationships. Medicine has a long history of development as an institution. Specific methods have been developed there to help nurses to cope with these negative phenomena. One of these coping techniques is resilience training through the practice of mindfulness and self-care and building resilience and well-being (Cochran et al., 2020). Allowing nurses to transition between roles and improving their orientation and workplace environment all contribute to reducing the likelihood of their turnover (Lockhart, 2020). Sharing governance with nurses may also avert the possibility of turnover (Hess, 2020). It is also worth mentioning group rational emotive behavior therapy that was proven to be able to “…reduce nurses’ job stress and burnout and increase job satisfaction and organizational commitment” (Kim & Yoon, 2018, p. 432). All these strategies are applicable in the setting of a governmental hospital in Jeddah.
The Best Approach to Cope With Burnout and Turnover in Nurses
I believe that the coping technique I could best apply would be shared governance. As a nursing manager, I have a significant professional background in teaching nurses managerial practices and the ability to engage them in the management of the health care organization. Such an approach would allow nurses to “…control clinical decision-making and, with managers, influence the resources that support their practice” (Hess, 2020, p. 37). It would create not only a consensus between managers and staff but also a connection through which each of the two groups could understand their emotional states and respond to the workplace issues in time. Introducing flexible working arrangements would be an effective way to combat nurses’ absenteeism and improve employee retention (Weale et al., 2017). Flexible working hours could be implemented through shared decision-making.
Kim, H. L., & Yoon, S. H. (2018). Effects of group rational emotive behavior therapy on the nurses’ job stress, burnout, job satisfaction, organizational commitment and turnover intention. Journal of Korean Academy of Nursing, 48(4), 432-442. Web.
Contemporary healthcare organizations face nursing shortages, challenging administrators to retain experienced ones. Shah et al. (2021) assert that burnout and turnover rates are significantly high due to long shifts, which take more than 40 hours per week, inadequate staffing, personal obligations, and a hostile work environment. There are disparate strategies to mitigate burnout and turnover to retain nurses.
Main body
The hospital can balance patient-to-nurse ratios to reduce burnout and turnover. Addressing many clients increases the levels of emotional exhaustion (Shah et al., 2021). Therefore, assigning caregivers a manageable number of patients is crucial to reducing burnout. This strategy also mitigates turnover and low client satisfaction. The hospital’s administrators can transform workplace features to address burnout as well. This step involves promoting positive nurse-doctor relationships, supporting educational programs, and fostering autonomy (Shah et al., 2021). Encouraging satisfactory collaborations and discoursing bullying ensures personal safety and genuine respect. Further, burnout can be mitigated by involving nurses in policy discussions regarding their work. Developing shared managerial programs is necessary to allow nurses to participate in work scheduling and workflow management. These strategies can help to promote a culture that recognizes a job-life balance.
From my perspective, the best strategy is to balance the nurse-to-patient ratio. It will reduce the chances of working overtime to allow nurses to have time for recreation and personal obligations. All professionals seek work-life balance; therefore, hospitals should offer overtime voluntarily (Shah et al., 2021). Working beyond the regular shifts increases stress levels, apart from limiting physical exercise and family relationships. In the end, the nurse experiences low work satisfaction, leading to a turnover.
Conclusion
Conclusively, burnout and turnover are the major problems affecting hospital organizations. The leading causes include inadequate staffing, hostile working environments, and long shifts. Some of the ultimate strategies to mitigate the issue include overtime elimination, fostering graduate and mentorship programs, promoting after-work relaxation, and establishing a pleasant nursing environment. The best strategy that the hospital can utilize is to balance the nurse-patient ratio. It will help caregivers to find time for personal responsibilities and recreation. Thus, hospitals should not use long shift hours to compensate for inadequate staffing.
Nursing is a health area characterized by a myriad of topics and issues. Nurses work with various people in diverse settings and employ concepts that each person may perceive differently from their life experiences. Therefore, health care providers must understand the specific meanings of words used in their practice. A concept analysis can help nurses determine definitions, purposes, and uses of concepts to make decisions appropriate for every case.
The Concept Analysis
Present the Concept
Nurses work directly with people and must communicate so that each party understands the implications behind distinct ideas. Dall’Ora et al. (2020) propose that features such as high job and psychological demands are associated with burnout in nursing. Burnout can affect both patient care and the providers of care (Dall’Ora et al., 2020). However, nurses may not always realize that they are experiencing burnout or how it can impact their practice. Therefore, one should develop the concept analysis of burnout to explore its general and nursing characteristics.
Determine the Purpose
Burnout can influence a nurse’s work, and it is important to determine whether it can be considered a diagnosis. In their article, Parker and Tavella (2021) mention a study that suggests a lack of clarity in distinguishing major depression from burnout. However, Parker and Tavella (2021) indicate that the latter shares several traits with one of the two depressive sub-types, non-melancholic depression. While the sub-type is a part of a clinical diagnosis, burnout does not seem to be one. Therefore, the purpose of the analysis is to fully comprehend the concept of burnout and its relation to one’s health.
Identify Uses
Burnout has several definitions and is used as both nouns and verbs. Merriam-Webster (n.d.) recognizes the concept as a lack of physical or emotional strength due to prolonged stress or frustration. The word can also refer to either an individual expressing the effects of drug abuse or the termination of operation, usually concerning rocketry (Merriam-Webster, n.d.). Burnout can mean the acts of destroying the property by fire or causing failure and exhaustion due to overwork or overuse (Merriam-Webster, n.d.). The concept is identified differently but seems to imply an ending of operating.
The concept of burnout has a similar meaning in considerable fields. The term was first introduced in 1974 to explain a loss of motivation and reduced commitment (Dall’Ora et al., 2020). Dall’Ora et al. (2020) mention that burnout occurs in response to emotionally demanding circumstances in work and life settings. Parental burnout is defined as a lengthy reaction to chronic and overwhelming parental stress (Griffith, 2020). In entrepreneurship, burnout refers to emotional fatigue, depersonalization, and decline of personal achievement (Omrane et al., 2018). In criminology, the concept is associated with lowered quality of life, cynicism, and employee absenteeism (Klinoff et al., 2018). Although connected to diverse areas, burnout is typically employed to describe high levels of stress that lead to poor performance.
Determine the Attributes
The definitions of burnout from psychological, parental, entrepreneurial, and criminology perspectives suggest three defining attributes. Burnout requires prolonged exposure to situations that cause high work overload (Merriam-Webster, n.d.; Parker & Tavella, 2021). Overwork leads to continuous stress represented by emotional exhaustion and a lack of internal resources (Dall’Ora et al., 2020; Omrane et al., 2018). Pressure provokes changes in behavior and attitudes and is associated with lowered quality of everyday performance (Dall’Ora et al., 2020; Klinoff et al., 2018). The attributes presented by overload, excessive stress, and changes in behavior characterize burnout as a process that can negatively affect many people.
Build a Model Case
” Casey is a registered nurse and works at a hospital. The hospital has been experiencing a staff shortage for several months, resulting in Casey often working overtime. She often had to skip launch breaks, sacrifice her sleeping schedule, and substitute for other employees. With time, co-workers have noticed that Casey became cynical towards the patients, reluctant to make decisions, and indifferent to everyday tasks. Casey’s family also witnessed that her cheerful personality changed, and she wanted to quit her job.”
The above model case demonstrates the three attributes of burnout. Casey has been overworking and lacking rest for a prolonged time leading to stress (Dall’Ora et al., 2020). Casey’s attitude towards work has changed as she became cynical and unconcerned (Dall’Ora et al., 2020). Moreover, her behavior outside the hospital has also altered, and she no longer wanted to work (Dall’Ora et al., 2020). The model case indicates that people must carefully manage burnout to prevent deteriorated mental health and control job turnover.
Build a Similar Case
“Cindy is a young woman who has recently given birth to her first child. Cindy has been on maternal rest for the past three months while her husband works. Cindy spends all her time with the child and does chores around the house. One day, Cindy tells her husband that she’s been tired. The husband realizes that Cindy needs more rest, as being a mother is demanding. They decide to hire a nanny to babysit their child a few times a week and reconsider their schedules to spend more time together.”
The above case illustrates one of the three attributes of burnout. Cindy’s husband recognized that she might have been exhausted before she started expressing symptoms of stress, which are emotional distancing and a sense of incompetency in parental burnout (Griffith, 2020). While the model case displayed signs that nurses should observe in themselves, a similar case shows a situation that health care providers should consider when assessing patients.
Build an Opposite Case
“Suzan has been a registered nurse for several years, and she loves her job. Sometimes, Suzan works overtime, but when she feels that she is becoming fatigued, she informs the management, and they find a substitution. Suzan provides care to every patient, but she prioritizes her health, knowing it can affect her work. Although they have hardships, all employees help and support each other.”
Identify the Antecedents and Consequences
The concept of burnout has specific antecedents and substantial consequences. Burnout is precedented by a lack of key resources at the workplace, organizational climate, the ambiguity of roles, and low levels of social support (Griffith, 2020; Omrane et al., 2018). Consequently, people can develop disorders associated with anxiety and depression, have conflicts, and experience psychosomatic symptoms, like chronic pain and high blood pressure (Griffith, 2020; Klinoff et al., 2018; Omrane et al., 2018). The antecedents cause stress, whereas the consequences can diminish mental and physical health.
Indicate the Empirical Methods
Several methods can measure burnout in settings such as the workplace and home. Burnout is primarily measured by the Maslach Burnout Inventory, assessing the key features of the concept (Parker & Tavella, 2021). Some studies also use the Professional Quality of Life Measure that views burnout as part of compassion fatigue (Dall’Ora et al., 2020). The Parental Burnout Inventory identifies parents at risk or experiencing burnout at home (Griffith, 2020). Each method can examine characteristics of burnout and assist in developing strategies to help people.
Conclusion
To summarize, the concept analysis of burnout demonstrates that it is used in many fields to determine the process of experiencing stress due to overwork that results in lower performance. Burnout can lead to negative changes in personality and conflicts at work and home. Although burnout is not a diagnosis, it can cause problems in one’s health that nurses must consider and predict while providing health.
The quality of healthcare primarily depends on professionals who provide patient care. However, the lack of staff and the need to serve more patients leads to overwork of professionals and burnout. This problem is common in the United States and leads to high turnover and reduced quality of care. Consequently, this problem requires detailed study from different perspectives to overcome it. For this reason, this literature review will examine the issue of nursing burnout from the perspective of causes, consequences, and interventions to find knowledge gaps and address them in future research.
Reasons for Nursing Burnout
A study of the literature demonstrates that many authors have considered various factors affecting nursing burnout. Mudallal et al. (2017) identify in their research that the main factors leading to burnout are high workload during shifts, low levels of autonomy, and inability to take part in decision-making. Dall’Ora et al. (2020), in a systematic review, confirms the influence of these factors and also notes the impact of such aspects as poor social climate and low rewards.
Other authors also look at nurses’ personal traits that are predictors of burnout. Pérez-Fuentes et al. (2018) note that low emotional intelligence, in particular the ability to manage emotions, interpersonal communication skills, and stress management, is a factor that reduces resistance to burnout. At the same time, Manomenidis et al. (2017) find that nurses with high self-esteem are less likely to experience burnout. Thus, scientific research demonstrates that the topic of factors affecting nursing burnout is well-researched.
Consequences of Nursing Burnout
The second category of literature examines the impact of burnout on health care quality. Pérez-Francisco et al. (2020) find that high workload causing burnouts degrades patient care and safety. Dall’Ora et al. (2020) add that the consequences can be adverse events, reduced job performance, medication errors, infections, low patient satisfaction, and intention to leave. The intention to leave is also associated with many factors that influence how nurses perceive their work. Ruiz-Fernández et al. (2020) determine that burnout leads to nurses’ illness, compassion fatigue, and low compassion satisfaction. In other words, nurses feel both physical exhaustion and emotional stress. However, there is no study in the literature that looks at the effect of burnout on nursing empathy, which is one of the keys to quality care.
Interventions
Many researchers study the impact of different interventions to prevent burnout based on specific factors. Adams et al. (2019) find that cultural changes such as increased leader engagement and support, shared decision making, and meaningful recognition reduce the likelihood of nursing burnout. At the same time, Wu et al. (2020) determined that supportive transformational leadership can prevent nursing burnout while a positive spiritual climate increases the value of nursing work. These articles show that since one of the leading causes of burnout, such as high workload, cannot be overcome in the current circumstances, nurses must take action that can reduce the impact of the problem.
Conclusion
Thus, a literature review demonstrates that most aspects of nursing burnout are well researched; nevertheless, the literature has one significant gap. The researchers did not look at the impact of burnout on nursing empathy, which can be increased or decreased due to physical and mental fatigue. A nurse who cannot be empathetic cannot fully understand the emotional needs of patients, while a nurse who takes patients’ problems too closely cannot cope with emotional stress. Therefore, since this ability is one of the key skills for a nurse to work with patients and their families, its correlation with burnout needs to be studied.
References
Adams, A., Hollingsworth, S., & Osman, A. (2019). The implementation of a cultural change toolkit to reduce nursing burnout and mitigate nurse turnover in the emergency department. Journal of Emergency Nursing, 45(4), 452-456. Web.
Manomenidis, G., Kafkia, T., Minasidou, E., Tasoulis, C., Koutra, S., Kospantsidou, A., & Dimitriadou, A. (2017). Is self-esteem actually the protective factor of nursing burnout? International Journal of Caring Sciences, 10(3), 1348-1359.
The effective and responsible performance of nursing duties requires compliance with a wide range of conditions regarding both the professional duties for this type of activity and the moral and ethical principles of work. Tense schedules, dynamic care environments, and other factors are the result of nursing staff fatigue, which can eventually develop into burnout. In contrast, high rates of resilience developed through self-regulation and educational interventions can help overcome job stressors and stimulate productive activities. As a result, finding optimal fatigue mitigation approaches improve performance. This work aims to identify the relevance of the problem of burnout among nurses, critically evaluate relevant academic sources, and suggest rational ways to solve the issue based on the data collected.
Background
The importance of studying burnout among nursing staff is due to the negative impact of this condition on employees’ performance, which, in turn, affects patient outcomes. The less productive nursing staff are, the lower the likelihood of successful nursing interventions. According to Tahlil (2022), the state of burnout can be characterized by a positive correlation between increased workload and reduced job resources. In other words, nurses cannot maintain a consistently high pace of work due to personal constraints, such as fatigue, and external factors, including high workloads and low supervision. Wu et al. (2016) draw a parallel between burnout and the phenomenon of compassion fatigue, when nurses, devoting themselves to their profession comprehensively and making many efforts to meet patients’ needs, experience emotional exhaustion. Therefore, one can note that the reasons for the development of burnout can be different, which explains the significance of studying this topic and finding appropriate mitigation approaches.
Particular attention to the problem of burnout among nurses is due to excessively increased needs for their services. Clinton et al. (2022) consider this issue in the context of the current COVID-19 pandemic and note that along with burnout, high turnover rates are a consequence of the work burden on nursing staff and the entire medical community. The need to create conditions in which junior medical staff can work without experiencing physical and emotional exhaustion is an urgent task of the modern healthcare system. According to Hopp and Rittenmeyer (2021), work fatigue can be minimized through innovative solutions associated with the practice of medical professionals. However, not all healthcare facilities can afford to implement optimization solutions for a number of reasons, such as financial constraints or labor shortages. Thus, studying the problem of nursing burnout is extremely important for this occupation and the entire medical community.
Literature Review
In academic literature, the problem of nursing burnout is often discussed due to the significant impact of this issue on the work process itself and related factors, for instance, patient outcomes. Smythe et al. (2017) study the experience of junior medical staff working in nursing homes and note the high value of theoretical training of specialists. According to the authors, educational interventions can help address the problem at the local level if nurses’ experiences are low and employees lack knowledge about how to deal with burnout (Smythe et al., 2017). In a similar study, Dev et al. (2018) evaluate the impact of such a quality as self-compassion in the context of combating work fatigue. They argue that coping with stressful conditions through attention to one’s feelings and emotions is a potentially effective tool for medical professionals in combating burnout (Dev et al., 2018). This argument is presented as valid, but the problem persists if employees do not have sufficient work experience.
Numerous stressors are key causes commonly associated with burnout in nurses. Ching et al. (2020) note that to successfully cope with high workloads and emotional exhaustion, nursing staff should increase self-awareness through honing reflection skills. At the same time, the level of specialists’ preparedness and the specifics of the external environment, for instance, the work schedule and the size of the team, can be constraints that prevent successful self-help. Mäenpää et al. (2017) link the burnout factor with the motivation score and study how engagement in the work process correlates with fatigue. According to the researchers, nursing education is a source of critical knowledge on how to implement professional skills through the use of flexible work strategies (Mäenpää et al., 2017). However, not every organizational environment may be suitable for applying the available knowledge and skills, which is a barrier to the implementation of approaches to increase motivation and strengthen inclusiveness in a medical organization.
Along with the aforementioned motivators and stressors, additional criteria are usually taken into account when analyzing the impact of burnout on nursing performance. As Van Bogaert et al. (2017) state, employees’ personal characteristics often affect job satisfaction, and such aspects as the level of communication, the sustainability of group activities, and other collaborative criteria can correlate with burnout. In other words, poor teamwork can be a prerequisite for emotional exhaustion in medical staff. Many studies, such as that by Hancock et al. (2020), view the criterion of resilience as one of the key factors associated with productive nursing practice. The authors remark that based on a survey of involved medical specialists, organizational challenges, a high frequency of stressful situations, and poor teamwork are rated as the causes of weak resilience (Hancock et al., 2020). As a result, a number of criteria are crucial to consider to draw a conclusion about the prerequisites for the development of burnout in nurses.
Critique of the Articles
Quantitative
The theory of resilience is a concept relevant to the issue of nurse burnout. In their quantitative study, Dev et al. (2018) seek to elucidate relevant characteristics influencing the manifestation of resilience among nursing staff. Through the involvement of target participants, the authors identify what criteria are decisive in the formation of resilient attitudes and the ability to withstand the risk of burnout (Dev et al., 2018). The components of this theory include relevant variables that relate to the manifestations of the issue. The researchers identify demographic (gender, age, ethnicity, and other parameters) and clinical practice (experience, work patterns, and other parameters) factors as independent variables and a resilience level as a dependent one (Dev et al., 2018). By using these criteria, it is possible to assess how resistant nurses are to burnout manifestations and how effectively they can withstand job stressors.
Qualitative
The theory of resilience does not originate in the nursing profession but in the psychological disciplines. In their qualitative study, Ching et al. (2020) describe the origin of this concept and consider it as a framework that defines the ability to adapt to specific conditions and recover when faced with negative experiences. Applied to nursing practice, the idea of resilience defines how effectively nurses can deal with high workloads and stressors that are inevitable. Ching et al. (2020) also cite factors that increase resilience, such as peer support, real success in interacting with patients, sufficient autonomy, and some other criteria. Through interviews with target participants, the authors have found a positive correlation between self-regulation mechanisms and low burnout scores (Ching et al., 2020). Thus, the theory of resilience largely determines how successfully nurses can withstand job stressors.
Intervention Protocol
Enabling nurses to increase their level of self-awareness to successfully deal with burnout risks is a key intervention protocol strategy. As Dev et al. (2018) state, addressing the individual characteristics of medical employees should be a must because their personal and clinical practice characteristics are distinctive. Similar ideas are presented in the study by Ching et al. (2020) because the authors insist on the need to strengthen nurses’ self-regulation strategies to successfully cope with stressors that affect the perception of the care process. As the tools to apply, Hancock et al. (2020) recommend turning to constructive coping practices related to employees’ individual characteristics and interests while considering their personal drivers. Finally, Van Bogaert et al. (2017) argue that nurses’ self-management competencies are directly dependent on the workload indicator, which can be excessive and thus cause burnout. As a result, relevant resources emphasize the value of a personalized rather than mass solution to the problem. Thus, by combining the findings from relevant sources, one can note that promoting individual self-regulation practices is a potentially valid methodology to create an environment in which healthcare professionals can overcome burnout prerequisites.
Despite the potential value of the considered strategy for addressing the burnout problem, some limitations can be identified based on the assessment of relevant sources. In the study by Dev et al. (2018), data is collected through self-reporting, and although participants have a personal interest, their responses may be subjective and biased due to distinctive experiences. Regarding the study by Ching et al. (2020), data collection through focus groups is a potential limitation. Emphasis on individual characteristics is key, but the cumulative evaluation of the issue can preclude objective information and lead to distorted data. Regarding the study by Hancock et al. (2020), deterrents refer to a limited number of constructive strategies to apply to overcome burnout. No additional algorithms are proposed except for those relating to the intersection of professional and personal factors. The findings by Van Bogaert et al. (2017) may be characterized in terms of limitations by analyzing the interpretation of the collected information. A cross-sectional design requires increased attention to analysis, and the risk of evaluation errors is high. All the listed deterrents are essential to take into account when drawing up an effective intervention protocol.
In the resources under consideration, the findings have an appropriate evidence base. For instance, Dev et al. (2018) conduct a correlational analysis by creating a unique framework for assessing the impact of potential barriers on nurses’ perceptions of the workflow. This allows for obtaining credible information substantiated by real statistical results. The study performed by Ching et al. (2020) helps the researchers identify the individual views of the participants involved on the issue in question through original interview questions. By categorizing the members’ responses, an adequate picture of the situation is presented, which allows for highlighting the relevant risk factors. A similar principle is applied by Hancock et al. (2020), who show the prerequisites for burnout in nurses visually by compiling the respondents’ answers in a special framework. This original approach shows the key topics associated with the problem under consideration. Finally, based on the collected data, Van Bogaert et al. (2017) demonstrate numerical ratios showing the respondents’ attitudes to emotional exhaustion in personal practice. All these approaches are valuable strategies for reflecting burnout prerequisites and arguing for intervention based on a personalized method.
Overall Evaluation and Summary
Following the aforementioned intervention protocol, which promotes self-regulation among nursing staff through a personalized approach, can help improve decision-making significantly. As Clinton et al. (2022) argue, targeting auxiliary educational offerings can help stakeholders, including employees and their supervisors, avoid unnecessary or inefficient procedures. In addition, according to the authors, streamlined decision-making is directly associated with cost savings through well-defined steps, which is relevant in the context of limited funding (Clinton et al., 2022). Having a clear idea of subordinates’ satisfaction with the work process, team leaders can allocate resources efficiently. Moreover, any healthcare institution can utilize a nursing self-awareness-based assistance model, which eliminates any problems associated with complex analytical projects. As a result, the considered protocol can be productive and financially beneficial due to the convenience of decision-making and the absence of useless initiatives to implement.
Improving clinical decision-making with the help of the protocol in question may be achieved due to a sufficient and credible evidence base. From a patient care perspective, Hopp and Rittenmeyer (2021) argue that “evidence-based clinical decision-making is the individualization of care to the context of the patient’s situation” (p. 14). In relation to junior medical personnel, the same principle is relevant. Gathering objective data from target nurses can help personalize the intervention and select appropriate interaction algorithms to enhance self-awareness and increase knowledge about how to deal with job stressors. In addition, as Hopp and Rittenmeyer (2021) state, the nature of the evidence plays a crucial role. The authors highlight the value of qualitative evidence in the context of clinical decision-making (Hopp & Rittenmeyer, 2021). This is due to the distinctive needs and preferences of the target audience, as well as changing views on the aspects of the workflow. The proposed implementation protocol is based on the interpretation of qualitative data, which indicates the potential to improve the clinical decision-making process.
Conclusion
The analysis of relevant academic sources and the collection of a credible evidence base has allowed for compiling an intervention protocol designed to address the problem of burnout among junior medical staff. Emotional exhaustion that many nurses experience is a severe problem and can have a negative impact not only on employee productivity but also on patient outcomes. As an appropriate intervention, increasing self-awareness through educational mechanisms is seen as a universal method of helping employees with distinctive work experiences and cultural backgrounds. Despite the limitations identified in the analyzed academic resources, their usefulness is significant for the topic under consideration. Improving clinical decision-making through the personalization of support programs and cost reduction are the value implications of the proposed intervention.
Burnout happens depending on the level of stress in the working place and nurses of different practices might be more subjected to emotional tension compared to others. According to Abellanoza et al. (2018), many researchers in the medical industry became interested in burnout and how it can be caused. Consequently, the study regarding ER nurses and the effect on their emotional stability was conducted to find out how the problem occurs and what are the common ways to avoid it. The sample size is small and equals five nurses from one medical organization. With the use of specific combinations and computers, the most realistic result was detected. There are approximately more than 2.75 million nurses in the USA and the number is increasing every year causing about 40% of burnout (Abellanoza et al., 2018). Nurses working in the emergency room are at a higher risk of stress as they are required to make quick decisions and work in a tense environment every day compared to nurses in the general practice.
The authors have used data from the past studies and approved them with the latest findings to make the evidence more reliable. Moreover, by collaborating with IT experts all calculations were done accurately to ensure the validity of the measurements. The data was analyzed from personal and financial aspects to understand how both aspects are related. It was found out that nurses’ burnout can cause financial problems to medical organizations as there will be a lack of workers. Also, over the 12-month period, the patients’ experience might decrease causing more stress on nurses who are not working in the emergency room (Abellanoza et al., 2018). The authors did not mention conflicts that appeared during the study, but it remained complicated to collect data outside the US.
The study shows that motivation, leadership, and career growth may decrease the level of burnout but increase the general dissatisfaction with the work. Many previous types of research only state the fact of nurse burnout, but the findings of Abellanoza et al. (2018) have supported the point as a valuable examination result. Consequently, this topic is crucial for clinical practice as it shows the psychology of nurses, in what cases the stress appears, and what are the most common solutions to this problem that might decrease the efficiency of the medical sphere.
