Burnout in psychiatric nursing practice
ONDRIOVÁ I. FERTAĽOVÁ , T Faculty of Health Care at Prešov University in Prešov Introduction: psychiatric nurses working at the workplace are exposed to stressful situations quite often the brunt of the current family life are multiplied Implementing demanding profession. Often they face the crisis situations, such as violence, escape, death of patient suicide attempts. At the moment, it always excessive stresses which can lead to nurses in burnout.
Aim: The aim of this study was to map the incidence of burnout in psychiatric nursing practice, comparison of the incidence by type of work and monitoring the effects of selected demographic characteristics of the burnout syndrome
Material and Methods: A collection of information, we used a standardized questionnaire Burnout Measure (BM) - Burnout questionnaire. The collection of data through a standardized questionnaire was conducted in January 2015 - January 2016, health facilities and Prešov region Košice region. Was distributed together 130 questionnaires, of which 130 were returned, so the return is 100%.
Results: In our group of nurses, we conclude that the highest score BM Index reached a divorced sister (overall average BM 3.87) and the lowest level of burnout among nurses showed a single (overall average BM index 2.86). This situation has a significant impact in our opinion that the burnout syndrome affects not only the work environment but also family background, social and family contacts or the presence of a loved one in the form of a life partner. Even on the basis of these facts may have divorced sister BM indices higher average than married sisters, respectively. free. Based on the statistical processing, the significant relationship between the variable marital status and the incidence of the syndrome did not show. BM highest average index reached a sister group B with seniority of 15 years - BM value of 3.52. Whereas the lowest index reached BM sister group, operating in five years - BM index value of 2.63. Based on these results, we can therefore conclude that the incidence rate of burnout increases with seniority and comparing files in both sisters.
Conclusion: shift work in nurses, emergency situations that require immediate decisions, interacting with patients and relatives, death proximity and high level of responsibility causing excessive mental load. Mental hygiene as a means to improve and maintain mental health nurse extremely important. Key words: nurse, stress, psychiatric ward, burnout
Theoretical background
Burnout syndrome is a well-known phenomenon today, when a state is
reached of extreme exhaustion, inner distancing, a strong decline in
performance and various psychosomatic disorders, though it is not officially a
disease [14]. According to ICD / International Classification of Diseases of the
World Health Organization / burnout syndrome is included in the additional
category of diagnoses, therefore it is not classified as a disease. Burnout is
legally recognized as an occupational disease in two countries, in
1. The first phase is marked by the
enthusiasm with which the person enters employment. After the excitement has
subsided, usually motivating forces other than enthusiasm become more prominent
(usually money)
2. Phase of utilitarian interest;
the person works, but wants to know “what for?”
3. The third phase is the “ash phase” – the person and his enthusiasm extinguished, losing respect for the value of other people, things, the objective and even himself – he will fall into an existential vacuum, his life meaningless [1].
Duty nurse in psychiatric department
Psychiatry is a fundamental medical fields. Its role is to diagnosis,
treatment and prevention of mental illness. The importance of Psychiatry at
present is increasing, as it increases the number of patients who are exposed
to psychosocial stress, increasing the number of broken and incomplete
families, increasing the availability of drugs and other drugs, and the
prolongation of life can be observed increase of the number of Alzheimer's
patients. The aim of nursing care for people with mental disorders is the most
patient support capabilities and its natural hinterland so as to be able to own
as much as possible to deal with their problems. Nurses working in psychiatric
workplaces today cope with the many soothing techniques - basal stimulation,
soothing nonpharmacological interventions, but especially talk therapy. Care is
also difficult for patients with institutional treatment that the treatment
ordered by a court. If the nurse fails to win the confidence of the patient in
the early days, then it is not possible to build a long-term therapeutic
relationship that is necessary for treatment. (10) In recent years,
professional stress nurses pays more attention to. The studies determine risk
factors in working life sisters that can lead to physical and mental
exhaustion. The unfavorable situation sisters contributing factors such as:
irregular working rhythm, restrictive working conditions associated with a lack
of nurses and auxiliary staff of the resulting time pressure, insufficient
material - technical equipment, poor economic situation deteriorated
interpersonal relations in the workplace and little support and motivating
environment by senior staff. Not less significant risks in nurses' work are:
death, dying and suffering, personal and professional expectations, the length
of professional experience, physical durability, reduced self and others. In
view of high job demands and low appreciation of the work nurses, each sister a
primary prerequisite to the emergence of burnout.
Prevention of burnout syndrome
Kebza, Šolcová [2003] based on the results found in the survey that investigated the prevalence of burnout among nurses in intensive departments and standard types of department, proposes the following protective recommendations for clinical practice:
More and more authors now highlight the role of teambuilding in preventing burnout among health professionals. Teambuilding uses specific procedures aimed at developing group processes, interpersonal ties and social interactions. It focuses on building self-confidence and quality of human relations. Thus it also indirectly affects conflict resolution, smoothes over problematic issues [13]. The problems of medical facilities, demands of nursing work, difficulties of communication of nurses with colleagues and with patients are the reasons that justify the use of teambuilding as a tool for improving the quality of our work, teamwork and to protect nurses from burnout or frustration [7].
EMPIRICAL SECTION
Definition of research problem
The paper is focused on the issue of
burnout syndrome and its occurrence in nursing practice.
Formulation of hypothesis:
H1 We expect
that there is a statistically significant difference between the averages of BM
indices (BM index - the result of the standardized Burnout questionnaire) for
nurses working in standard inpatient departments and nurses working in
intensive care workplaces,
H2 We expect
that there is a statistically significant relationship between the averages of
the BM indices and age of nurses
H3 We espect that the relationship of religion and values BM
index is not statistically significant
Research methodology
The aim was to determine the prevalence of burnout in the nursing
profession. Information and data necessary for our investigation were obtained
through a standardized questionnaire BM – Burnout Measure – of psychological
burnout. The aim was to determine
the prevalence of burnout in the nursing profession. Information and data
necessary for our investigation were obtained through a standardized
questionnaire BM – Burnout Measure – of psychological burnout. The collection
of information, we used a standardized questionnaire Burnout Measure (BM) -
Burnout questionnaire. The second part consists of a standardized questionnaire
Burnout Ayala M. Elliott Aronstona Pinesovej and 1981 (taken from the book Half Křivohlavý - How not to lose enthusiasm. The
data obtained through a questionnaire BM (Burnout Measure) Ayala Pinesovej and Eliot Aronson was analyzed
using the Mann - Whitney U test, as well as using the Kruskal-Wallis
test. For each hypothesis we specify which test was used. Kruskal-Wallis
test used in cases where we want to determine whether there is a statistically
significant difference between the two groups over the values obtained. Statistical
analysis of data using the above non-parametric tests realized the significance
level of 0.05. The level of significance to us is a level of risk that we take
the wrong argument, that we accept the argument that in fact the case.
Characteristics of respondents
The choice of respondents was
deliberate, it was a systematic mechanical selection, and the criterion was
working in a standard inpatient department or department of inpatient intensive
medicine. The total number of distributed questionnaires was 130, of which the
return rate was 100%.
Implementation of research
The collection of data using the standardized questionnaire was
conducted in the months of January 2015 - January 2016, at health facilities of
the Prešov and Košice
regions. A total of 130 questionnaires were delivered, of which 130 were
returned, so the return rate was 100%.
Analysis and interpretation
of research results
H1 We expect that there is a statistically significant difference
between the averages of BM indices (BM index - the result of the standardized
Burnout questionnaire) for nurses working in standard inpatient departments and
nurses working in intensive care workplaces.
In hypothesis H1 we want to discover
if there is a statistically significant difference in average BM Index for
nurses in standard inpatient departments. We evaluate the hypothesis based on
the Mann-Whitney U test as we are comparing the difference in two groups.
Tab. 1 Average value of BM index
|
Type of workplace |
Average value of BM index |
|
Inpatient department A |
(n-65) 3.44 |
|
Department of intensive
medicine B |
(n-65) 3.66 |
Statistical analysis for hypothesis H1
The calculated value of the test
characteristic p is 0.589, which is a value greater than the significance level
of 0.05, i.e. P = 0.589> α = 0.05. Based on the validity of this
relationship, we have not confirmed the assumption of hypothesis H1 and
therefore it holds that there is no statistically significant difference in the
average BM Index of nurses working in standard types of inpatient departments
and intensive care workplaces. We can search for the consequences of this
non-confirmation, for example, in the subjective assessment of respondents, age
structure of the respondents etc. Therefore we cannot generalize the
conclusion, is valid only for the sample of respondents analysed by us. A
general conclusion would require a broader set of respondents.
H2 We expect that there is a statistically significant relationship
between the averages of the BM indices and age of nurses
Tab. 2 Relationship between BM index and age of nurse
|
Questionnaire item |
Standard departments |
Specialised departments |
||
|
n |
% |
n |
% |
|
|
Up to 30 years of age |
10 |
7.7 |
15 |
11.5 |
|
From 31 to 49 years |
36 |
27.7 |
29 |
22.3 |
|
Above 50 years |
19 |
14.6 |
21 |
16.2 |
Another item of identification, we mapped the
age of the respondents. The largest group of the total number of respondents
were nurses aged 31- 49 years numbering 65 (52.3%). In group A, the greatest
share was nurses aged 31- 49 years numbering 36 (27.7%), the second largest
group in this set were nurses over 50 years of age numbering 19 (14.6%). In
group B, the highest number of nurses were aged 31- 49 years totalling 29
(22.3%) and the second largest representation was nurses over 50, numbering 21
(16.2%). The smallest representation in both sets of nurses were those under 30
years of age, the number across 49 standard departments was 10 (7.7%) and in intensive
departments it was 15 (11.5%).
Tab. 3 Relationship of the value of the BM index, age and type of
workplace
|
AGE |
State of |
State of BM-B |
|
Up to 30 years of age |
2.75 |
3.12 |
|
From 31 to 49 years |
3.55 |
3.42 |
|
Above 50 years |
3.63 |
3.60 |
The average BM index reached by nurses in group B with more than 15
years of experience was 3.52. On the other hand, the lowest BM index was found
in nurses from group A working up to 5 years – with a value of BM index of
2.63. On the basis of these results we can therefore say that the level
occurrence of burnout syndrome grows with the number of years worked in both
comparative groups of nurses.
H3 We expect that there is no statistically significant relationship
between the marital status of nurses and averages of BM indices
In the identification item in which we mapped
the marital status of respondents, the largest group was married nurses with a
total number of 87 (66.9 %), of which 51 (39.2 %) were nurses from group A and
36 (27.7 %) were nurses from group B. A less numerous group was formed of 23
single nurses with 9 respondents from group B and 14 respondents from group A.
Tab. 4 Nurses by workplace
|
Questionnaire
item |
Group A |
Group B |
||
|
n |
% |
N |
% |
|
|
Single |
9 |
6.9 |
14 |
10.8 |
|
Married |
51 |
39.2 |
36 |
27.7 |
|
Divorced |
2 |
1.5 |
13 |
10.0 |
|
Widow |
3 |
2.4 |
2 |
1.5 |
Tab. 5 Relationship of the value
BM index, marital status and type of department
|
Marital status |
State of |
State of BM- Group B |
|
Single |
2.77 |
2.98 |
|
Married |
3.47 |
3.51 |
|
Divorced |
3.78 |
3.95 |
|
Widow |
3.57 |
3.23 |
The highest scores of BM index were
found in nurses in group B who were divorced - value 3.95, whereas the lowest
average BM index was found in nurses in group A when these nurses were single –
value BM 2.77. The most numerous group
in both samples were married nurses, where the average BM index was 3.51 in
group A and 3.47 in group B.
H3 assumed that the
relationship of religion and values BM index is not statistically significant
The
hypothesis 5 verifies the existence of a statistically significant influence of
religious values on the BM index. Analysis takes place via the Kruskal - Wallis test because we compare the existence of a
statistically significant difference between the 3 groups. The first group
consists of respondents who reported their religion as Catholic and BM showed
the average value of 3.67, the second group comprises respondents who reported
their religion as Protestant BM with average values of 3.51 and the third group is made up of 64 respondents who said, they have no religion, respectively.
another faith with BM index of 3.65.
|
|
|
|
|
Tab. 6 The relationship
between the BM index and beliefs
|
Religion |
Group A |
Group B |
Total |
|
Catholic |
3,35 |
3,38 |
3,67 |
|
Evangelical |
3,11 |
3,90 |
3,51 |
|
Without |
4,03 |
3,26 |
3,65 |
Statistical analysis of the hypothesis H3
The calculated value of
the test characteristic p is 0.215, which is a value greater than the
significance level of 0.05, i.e. P = 0.215> α = 0.05. On the basis of
the validity of this relationship, we confirmed that the nurses in view of the
belief there is no statistically significant difference in the diameters of the
BM. We confirmed the validity of the hypothesis third
Discussion
The most extensive study in the European Union dealing with burnout
among nurses is the NEXT study, with a target sample of 32,850 nurses, which
was carried out in 10 EU countries including
In hypothesis 1 we established that we expect statistically significance
differences of BM indices among nurses in groups A and B. We tested the
significance using the Mann-Whitney test with a significance level of 0.05.
The finding was that there was no statistically significant difference in the BM index for nurses in groups A and B. Hudáková [2011], in her paper, monitored the average BM indices among nurses working in standard departments compared to that of nurses working in outpatient departments using the same measuring tool as we do in our research. On the basis of statistical processing the sample showed statistical significance of the influence of the type of department on burnout syndrome. It concluded that the nurses working in inpatient departments are at higher risk of burnout, as their average BM Index value is 4, which is on the border of certifiability. It should also be noted that in small communities where the respondents know each other, even simple questions in which we ask for demographic information could lead the respondents to fear a violation of their anonymity. This can result in their not stating true feelings and responses.
In the second hypothesis we wanted to verify the statistical
significance of the relationship between the age of nurses and burnout, where
we expected that the relationship of age and burnout syndrome is statistically
significant.
The expectation of the hypothesis was confirmed to us, i.e. there is a statistical significance of the relationship. The relationship of the age of nurses and burnout is also mentioned by Morovicsová [2007], who conducted research among nurses working in departments of internal medicine and oncology. When analysing BM averages, we concluded that with increasing age, the average of BM indices increases. The lowest BM indices were nurses up to 30 years of age (average = 2.94 BM), while the highest was nurses over 50 years of age (average = 3.62 BM). The link between age and burnout is described by the Šeblová and Kebza [2007] , who analysed the incidence of the syndrome among emergency service workers. Haškovcová [2003] states that with increasing age, the number of nurses with a tendency towards and suffering from burnout also increases. According to the authors, an at risk groups is nurses between 18 and 29 years of age because of greater vulnerability, lack of experience in dealing with problems. There is also the opinion stated by Kebza and Šolcová [2003] that in terms of development of burnout syndrome demographic characteristics such as age, education, marital status or length of service are considered neutral factors.
In the third hypothesis the statistical significance of the relationship
of religion and burnout, we investigated the hypothesis through third
The calculated value of the test
characteristic p is 0.215, which is a higher value than the level of
significance, that is, the hypothesis is confirmed by us, that there is no
significant relationship between religion and burnout. Research and Rybářová Stejskalová
(2010) confirmed that religion is not a statistically significant factor in the
development of burnout. However, there are studies which suggest that religion
or spirituality has access to a significant impact on subjective well-being of
the individual, human resource spirituality to solve problems, even to prevent
burnout (Kebza 2005).The third hypothesis verified
the statistical significance of the impact of marital status on the occurrence
of burnout syndrome in nurses.
Conclusion
Based on the analysis of the results, we can conclude that the rate of
prevalence of burnout in the profession of nursing is significant. This is also
confirmed by available research and studies with these issues. Burnout is a
phenomenon that threatens every nurse, with a significant role in its
development played by various external or internal factors. The basis of
prevention, therefore in our view, is that nurses have knowledge about how to
prevent burnout and be able to use it in practical life. Finally, we also drew
attention to a proactive approach of hospital management on this issue.
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