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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
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The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
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Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
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The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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The Association of Burnout Syndrome among Nursing Staff in King Abdullah Medical City - Makkah Based on Specialty

Nada Jowhar Firaq*, Omar Z. Alsharqi

Nursing Administration Department, King Abdullah Medical City, Makkah, Saudi Arabia

Abstract: Background: Burnout remain significant concerns in nursing, affecting both individuals and organizations. Burnout is a challenging health problem. This problem is harmful to humans and health systems. Therefore, in recent years, particular attention has been paid to research on burnout, especially among the nursing professions. Objective: The study aim was to investigate the association of burnout syndrome among nursing staff at King Abdullah Medical City (KAMC) in the city of Makkah, based on individual nursing specialization and examining the possible existing relationships between the magnitudes of burnout syndrome with some variables. Subjects and Methods: The Study type was a Cross-Sectional design. Undertaken in a specialized hospital, Makkah, Saudi Arabia. Sample collected from 376 nurses working in different specialties. Data collection was done by using a survey questionnaire that comprises of two segments. The first part of the survey was containing sociodemographic data (gender, age, nationality...etc). On the other hand, the second part of the survey consist of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Results: The result showed that the emotional exhaustion has higher score which indicate the nurses have higher emotional exhaustion. Depersonalization shows lower score that means low burn out and personal accomplishment shows higher score that means the participants have more personal accomplishments. The finding shows that there is significance difference exist between Burn out among nursing staff with educational level and primary work area. There is no relationship exist between Burn out with years of experience and staff position. Conclusion and Recommendations: This research represents to the association of burnout syndrome among nursing staff. This finding can be used to identify contributing elements that are the primary causes of exhaustion among full-time nurses, as well as to investigate the scope and magnitude of burnout syndrome as experienced by full-time nurses. The hospital management should establish an action plan to reduce professional burnout among nurses by increasing participation and communication between professionals and management.

Keywords: burnout syndrome, nursing staff, specialty

Received December 05, 2021; Revised January 11, 2022; Accepted January 20, 2022

Citation: Nada Jowhar Firaq, Omar Z. Alsharqi, The Association of Burnout Syndrome among Nursing Staff in King Abdullah Medical City - Makkah Based on Specialty. American Journal of Nursing Research, 10 (1). 1-6. January 2022. doi:10.12691/ajnr-10-1-1

1. Introduction

Nurses often see themselves as the principal givers feeling that they must be able to give themselves completely to their patients without showing any signs of stress fatigue or depression. Nurses are, more often than usual, taken for granted and thus, the nature of the nurse-patient relationship is almost analogous to asymmetrical one where the nurses give, and the patients receives. The nursing career is one that has well known to be causing stress, anxiety and very overwhelming due to the elements constituting the tasks a nurse has to perform [1,2]. The accumulation of work-related stress and anxiety can lead to what is called, the burnout syndrome [3]. Burnout can be perceived as an acute stage and chronic work-related stress since stress is situational and can be temporary, whereas burnout can last for a considerable amount of time [4].

Nurse burnout goes beyond feeling tired or experiencing a bad day at work. It is defined as emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It impacts their personal lives, the patients they take care of, and the organizations they work for. Some researchers affirm that nurse burnout is the major factor in shortages of the number of full-time working nurses around the world [5]. Due to the shortages in the number of full-time working nurses, nurses may find themselves in the disadvantageous and uncomfortable position where they have to work for several consecutive days where the hours are very long (overtime) and without having sufficient to have a rest and recover from exhaustion and fatigue. In many countries around the world, nursing career has been hit with under staffing due to high turnover which ultimately causes nurses burnout. This burnout syndrome and its wide occurrence in the nursing career, can exacerbate the situation with the shortage of full-time professional nurses which eventually and inevitably adds to the burden of heavy workload on the working nurses. It was stated that: “Turnover among nursing staff can be very costly to an organization [6].

Burnouts affect nearly 37% of nurses per year in the United States of America (USA) [7]. A psychologist based in the United States of America, was the first author to identify the term “burnout” as a worker’s reaction to the chronic stress in many occupational job descriptions. Cañadas-De et al describe ‘burnout’ as a term referring to a condition of reduced self-achievement, depersonalization, and emotional exhaustion [8,9].

Burnout is associated with the working conditions in the nursing environment. Since its definition, the term ‘burnout’ in any professional or occupational environment has been intensely studied.

Lacking knowledge and resources to instruct nurses on the prevalence of burnout makes it challenging to diagnose, help to prevent, and possibly treat the health issue. As a result, it is perfect to carry out more studies on these concerns, to inform healthcare practitioners on how to reduce the implications of this phenomenon and the consequences it introduces to patient care [10].

2. Significance of the Research

Burnout is a rising concern amongst healthcare professionals and has been studied and classified as a psychological disorder, resulting from physical and emotional overload involved in patient care. Nurses suffering from burnout syndrome have a low personal implementation on their job description, depersonalization, cynical or negative attitudes towards patients, and emotional exhaustion.

As a build-up on existing literature, this research aimed to investigate the association of burnout syndrome among nursing staff at King Abdullah Medical City (KAMC) Makkah, based on individual nursing specialization. Notwithstanding the gravity of the situation with the burnout syndrome amongst nurses worldwide in general and in the Saudi context in particular, it is evident that there has been a lack of structural research in exploring the various elements which manifests itself eventually in the burnout syndrome. In addition to identifying the prevalence of burnout at King Abdullah Medical City –Makkah hospital, this study also explored the different strategies utilized in protecting healthcare professionals and practitioners from the potential effects of burnout. Additionally, this research also aimed to provide evidence-based information on how to curb the prevalence of burnout amongst nurses based at King Abdullah Medical City–Makkah. During the entire architecture of this study, the need to reform organizational habits and modifications in employee treatment was evaluated as a viable solution to the problem at hand.

3. Aim of the Study

The aim of this study was to disclose the association of burnout syndrome among nursing staff in King Abdullah Medical City. This aim was achieved through the following objectives:

1. To explore the extent and magnitude of the burnout syndrome as perceived by full time nurses at KAMC.

2. To assess the overall contributing factors which are the main causes of stress and exhaustion among full time nurses at KAMC and, ultimately, burnout among those nurses.

3. To examine the possible existing relationships between the magnitudes of burnout syndrome as it relates to varying specialized hospital units.

4. Subjects and Methods

4.1. Research Design, Setting, and Participants

This study was a cross-sectional research design that was carried out at King Abdullah Medical City–Makkah. Sample collected from 376 nurses working in different specialties.

4.2. Sample Size

The population in this study included all the nursing staff work in King Abdullah Medical City (KAMC). The population total number was 1020 in January 2021. The sample size for the study was estimated using Epi Info software program. The minimum sample size by total number of nurses is 280 using the sample size calculator at 95% confidence interval and 5% margins of error. We added an extra 10% for incomplete answers, and 30 participants in the pilot were added to the selected sample, resulting in a final sample of 376 nurses.

4.3. Tool of Data Collection

Data collection was done by using a survey questionnaire that comprises of two segments. The first part of the survey was containing sociodemographic data (gender, age, nationality, marital status, educational level, years of experience, primary work area, current position and working hours during each shift). On the other hand, the second part of the survey consist of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). The original form of the MBI-HSS was developed by Christina Maslach and Susan E. Jackson with the goal of assessing an individual's experience of burnout. The MBI contain total of 22 questions which are grouped into three categories, eight questions investigate personal accomplishment, and five others investigate depersonalization, whereas nine remaining questions evaluate emotional exhaustion.). Each scale measures its own unique dimension of burnout. The MBI is a Likert scale with 7 points and 22 items that each nurse self-reports from “never” to “daily” (6 = every day, and 0 = never).

5. Validity and Reliability

We evaluated the convergent validity through the factor analysis, and evaluated the discriminant validity through the Pearson's correlation analysis. This instrument also evaluated the reliability for three subscales of Maslach Burnout Inventory with the Cronbach's Alpha method, which assesses the internal consistency. The result ensures the reliability of the questionnaire, meaning that the instrument is reliable to measure the objectives of the study and acceptable for the researcher and we can rely on the results reached through it, which is Cronbach's α was 0.85 (overall scale), 0.91 (emotional exhaustion), 0.79 (depersonalization), and 0.84 (decreased personal accomplishment). One study supporting this that is a tool with high reliability and validity to assess burnout in personal service occupational groups, including nurses. [11].

6. Ethical Considerations

IRB approval was obtained from the KAMC research Center letter (21-785), dated 06/05/2021. After getting official permission from IRB, the online survey was distributed to the health care workers. For ethical consideration, the aim of the study and an information part explaining the study details was included in survey to obtain their cooperation. Participants was not identified on questions. In this way the researcher was maintained anonymity and confidentiality of the participants.

7. Data Collection

The investigator collected data from the participants by using online survey questionnaires. The data was collected from 15/05/2021 to 15/07/2021. The survey link was closed when the need number of respondents is achieved. An invitation part was included in the survey to understand the aim of the study to the participants and to obtain their cooperation. An information sheet was provided before starting to answer the questionnaires, which included meaning of burn out in nursing. The study samples were selected by using simple random method.

8. Statistical Analysis

The categorical variables were presented as frequency and percentage, while a Chi-tests performed to compare the quantitative variables between different groups of nurses based in various departments at the hospital. Analysis of variance (ANOVA) was utilized to look at statistical relationship between burn out among nurses and variables being studied. All statistical analyses were performed by using “Statistical Package for Social Sciences (SPSS)”, version 25 and P-values <0.05 were considered statistically significant.

9. Results

Table 1 illustrates that 70% of those who responded were female 30% were male participants and 177 participants 46.9% were aged from 30 to 35 years old. Of them, 292 married 77.5%. Most of the participants have bachelor’s degree (74.5%, n = 281), and 74% (n = 282) were staff nurse position, 58.6% (220) sample were working 12 hours shift. The majority of them were working in critical care area (27.3%, n = 102) remaining Ambulatory area (19.4%), oncology center (14.3%) surgical (10.6%), medical (10.3%) emergency room (9.8%) Operating room (6.4%) and cardiac medical and surgical (1.9%) respectively. In regard to the nationality of the participants 26.8% participants were from Philippines and 26.5% were Indians. Remaining Egyptians (15.6%), Saudi (14.3%) Pakistan (10.1%) Jordan (5.3%) and (1.1%) others and lastly 32.9% of respondents have 6-10 years of working experience and 29.2 % have 10-14 years 22.3% have 2-6 years and remaining 15.4 % have above 14 years of working experience.

Table 1. Sociodemographic characteristics of responses (n=376)

Table 2 shows that the mean score and deviation of the three dimensions are Emotional Exhaustion 18.875 (16.26), Depersonalization 6.914(6.83) and Personal Accomplishment 27.649(17.04). The result indicate that emotional exhaustion has higher score which shows that the participants have higher emotional exhaustion. Depersonalization shows lower score which shows low burn out and personal accomplishment shows higher score that means the participants have more personal accomplishments.

Table 2. Means and Standard Deviations for the MBI-HSS Scales

Table 3 represents that there is significance difference exist between Burn out among nursing staff and educational level. The overall burn out mean score was high in nursing staff having bachelor’s degree. In regards with years of experience the result showed that there is no significance difference between Burn out and years of experience. The total mean score was also indicating not much difference. When seeing the result, it shows that there is significance difference between primary work area and burn out among nursing staff (p<0.005). The staff working in medical department showing higher burn out mean score. When assessing the relationship between staff position and burn out among nursing staff the result shows that there is no significant relationship. The total mean score was also indicating not much difference.

Table 3. Relationship between Burn out and independent variables of the study

10. Discussion

This research project was aimed to disclose the association of burnout syndrome among Nursing Staff in King Abdullah Medical City. The nursing career is one that has well known to be causing stress and the accumulation of work-related stress and anxiety can lead to what is called, the burnout syndrome [3]. This survey was applied to overall contributing factors which are the main causes of stress and exhaustion among full time nurses and explore the extent and magnitude of the burnout syndrome as perceived by full time nurses and also to examine the possible existing relationships between the magnitudes of burnout syndrome.

The result indicate that emotional exhaustion has higher score which shows that the participants have higher emotional exhaustion. Depersonalization shows lower score which shows low burn out and personal accomplishment shows higher score that means the participants have more personal accomplishments. These results are consistent with the previous that burn out syndrome is mostly connected with the three most common domains, which are: emotional and physical exhaustion, cynicism and depersonalization [12]. Burnout syndrome in nursing, emotional exhaustion, and other recorded incidences are also causes and instigators of intention to leave among nurses around the world, according to other published articles [13]. Another study found that nurses had expended both physical and emotional energy in working as hard as they can in the hopes of receiving praise or recognition for their efforts [14].

Another objective of this was to identify the contributing factors which are the main causes of stress and exhaustion among full time nurses. The result of this study indicate that emotional exhaustion has higher mean score which means the nurses have higher emotional exhaustion and similar results published in some nursing articles Gómez-Urquiza et al define emotional exhaustion as a loss of energy and a depletion of emotional resources [15]. According to a study done by the American Nurses Association, 50 percent of nurses were emotionally drained after concluding their shifts [5]. Previous research has found that stress from the social and physical working environment, management, and job ambiguity are substantially associated with emotional exhaustion among medical practitioners [16]. Nurses with burnout syndrome have a poor personal execution of their job description, depersonalization, cynical or negative attitudes toward patients, and emotional weariness [17], and they eventually feel exhausted and disoriented [18].

The overall burn out mean score was high in nursing staff having bachelor’s degree. This result supporting by previous studies that the greater job responsibilities associated with higher education and this will lead to higher burn out syndrome [9]. Another study explaining that educational background has a significant influence in the dimension of emotional exhaustion and depersonalization [19].

Other result shows that there is no significance difference between burnout and years of experience. The total mean score was also indicating not much difference. There are no many studies that have looked into the experience of nurses with burn out syndrome but one of the published result shows that burnout syndrome affects approximately 40% of nurses working in normal hospital contexts, which may be linked to lengthy working hours. [20]. According to one study, having more experience in a career is linked to changes in the body's biological functioning, which can lead to a variety of mental and physical illnesses, including burnout syndrome [15]. According to some research findings, the group of nurses with 5-10 years of experience scored higher than the other groups in terms of emotional exhaustion and depersonalization. In terms of low personal accomplishment, the group with fewer than five years of nursing experience outperformed the other groups [19].

Another result in this study shows that there is significance difference between primary work area and burn out among nursing staff and the staff working in medical department showing higher burn out mean score. This result has relation with other findings that an important area of the research on BOS in nursing which has not received its fair share of studies, is the region in nursing where the amount or size of BOS related to the specialisation department with which the individual nurse works. Poncet et al found that over 30% of intensive care unit (ICU) nurses experienced significant BOS [21]. Similar studies have found that nurses working in oncology departments and palliative care units are more likely to have BOS [22,23].

The final result of this study result shows that there is no significant relationship between staff position and burn out among nursing staff. However, it is not being able to find any previous study, either in health care settings or in other environments, which has identified the relevance of this particular triad of characteristics or how they are interlinked. One of the findings shows that Job position affected the intensity of emotional exhaustion and depersonalization [20].

11. Conclusion

This is a cross-Sectional study of a random sample of hospital staff nurses from different specialties. The perceptions about the association of burnout syndrome among nursing staff were described. Nurses reported that their burnout to be at a moderate level. The study results highlight that that nurses have higher emotional exhaustion, lower depersonalization and more personal accomplishments. This finding can be used to identify contributing elements that are the primary causes of exhaustion among full-time nurses, as well as to investigate the scope and magnitude of burnout syndrome as experienced by full-time nurses. Addressing such, an issue will also aid in the education of nurses' perspectives on burnout syndrome. This study's findings suggest that organizations should invest in initiatives to reduce nurse burnout, which, if effective, are likely to have a good return on investment and boost nursing-sensitive quality of care indicators. This study adds to the body of knowledge in the industry by demonstrating that nursing practitioners are more likely to suffer from burnout syndrome. The study result also concluding that relationship between burn out among nursing staff with educational level and Primary work area. The hospital management should establish an action plan to reduce professional burnout by increasing participation and communication between professionals and management. This research can be used to support future interventions in which workers and managers collaborate to develop strategies that take into account associated factors in order to avoid or reduce levels of burnout syndrome and, as a result, maximize quality of life in the workplace, thus improving patient and family care.

12. Recommendations

This study's findings will aid healthcare leaders in better understanding the factors that contribute to burnout in health-care organizations. The implications of this study's findings will aid hospital management in developing an action plan to control nursing staff emotional tiredness. This study suggested that health-care organizations concentrate on applying well-known techniques to reduce burnout, such as proper nurse staffing and limiting the number of hours worked per shift.

13. Limitations of the Study

The study's limitations originate from the cross-sectional design, which allows only for the investigation of connections between variables and does not allow for the establishment of causal relationships. Furthermore, because all of the data was self-reported, the responses may be influenced by the respondents' interests and attitudes. There are likely to be other factors that influence these outcomes in addition to those examined in this study. Information was gathered over a period of several days. However, it is possible that some nurses will be excluded from the study due to their inability to work due to medical reasons or vacations. As a result, only "healthy personnel" are enrolled, limiting the scheme's effectiveness.

References

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