Burnout and productivity among Iranian nurses

Assessment of the quality of nursing work life and its related factors among critical care nurses

Background

Quality of work life (QWL) refers to the degree to which employees contribute to the organization's goals while also experiencing personal and professional satisfaction. This study conducted to evaluate the quality of nursing work life (QNWL) level and its associated factors among nurses working in critical care units.

Methods

A convenience sample technique among critical care nurses in Jordan by using a cross-sectional, descriptive design. A self-reported questionnaire was used. A Pittsburgh Sleep Quality Index (PSQI), and the Andersson and Lindgren questionnaires scale were used in data collection.

Results

The total mean scores of QNWL were M = 86.17 (SD = 35.12), which is slightly below the expected middle value (87.5). The nurses have a higher psychological relation, M = 18.28 (SD = 8.99), whereas they have the lowest competence development, M = 11.44 (SD = 5.56). There was statistical significance between workplace noise, and workplace sources of noise, quality of sleep and QNWL.

Conclusion

The outcomes also highlighted the significance of undertaking additional interventional research studies in the future in order to identify practical strategies to improve nurses QNWL. As a result, the nursing care given to the patients and their families may be improved.

Mediating effect of sleep quality on the association between job stress and health-related productivity loss among workers in R&D enterprises in Shanghai

Background

Past research indicates that occupational stress negatively predicts health-related productivity. Simultaneously, sleep problem among workers may stem from job stress, subsequently leading to a decline in sleep quality and resulting in reduced health productivity. Therefore, this study aims to idenitify whether the sleep quality of employees functions as a mediator in the process through which job stress impacts health productivity.

Objectives

This study aimed to assess the status and analyze differences in quality of sleep, job stress, and health-related productivity loss (HRPL) among workers in research and development (R&D) enterprises in Minhang District, Shanghai. We also assessed the mediating effect of sleep quality on the relationship between job stress and HRPL.

Methods

A total of 3,216 workers in R&D firms aged between 18 and 60 years participated in this study (mean age 35.15 years; standard deviation 8.44; male-to-female ratio≈2:1). The Nakata Insomnia Questionnaire, the Chinese version of the Brief Job Stress Questionnaire revised edition, and the Chinese version of the Work Productivity and Activity Impairment Questionnaire were used in this study. And the Kruskal-Wallis test, Hierarchical Multiple Regression Analysis, and Path Analysis were utilized for data analysis in this study.

Results

There were significant differences in the positive detection rate of insomnia among participants according to age, educational level, marital status, position, length of service, and level of financial difficulties (all P < 0.05). We also found significant differences in the positive detection rate of HRPL among participants according to age, marital status, length of service, and level of financial difficulties (all P < 0.05); participants with insomnia scored higher for HRPL than those without insomnia (6.00 vs. 4.20, P < 0.001). Additionally, participants with job stress problems had higher HRPL than those without these issues (7.00 vs. 4.20, P < 0.001). Our findings suggest that sleep quality plays a mediating role between job stress and HRPL (all P < 0.05).

Conclusions

Occupational health professionals must pay particular attention to job stress, sleep quality, and their influencing factors to positively influence the wellbeing of workers while improving productivity.

Influencing factors of the treatment level of elderly care workers and their career development prospects

BACKGROUND

The increasingly aging population in current China has encouraged the emergence of the diversified and multi-level elderly care service industry, and the demand for high-quality elderly life with the help of elderly caregivers continues to grow.

METHODS

Based on the existing questionnaire data, this article explores the influencing factors of the treatment level of care staff, and explores their future development prospects.

RESULTS

The results show that whether they have participated in relevant vocational skills competitions, whether they have worked overtime, whether they have overtime wages, and their monthly income have significant effects on their satisfaction of treatment levels. Elderly care workers who have participated in skills competitions are more satisfied about their salary. In addition, workers who rarely and occasionally work overtime are more satisfied compared with those who have never worked overtime; Caregivers with a monthly income of 5,000-6,999 yuan are more satisfied with their salary and treatment than those with below 3,000 yuan.

CONCLUSION

Therefore, in order to better match the supply and demand of care workers, we should provide formal training and skill competitions for them, appropriately increase their salary level and reasonably arrange their working hours, so as to attract more professional talents into elderly care industry.

Changes in Nurses' Sense of Calling During the COVID-19 Pandemic: A Qualitative Study

This study investigated changes in nurses' sense of calling during the COVID-19 pandemic, as well as possible reasons for these changes. A total of 440 nurses in Turkey responded to a single open-ended question about their work attitudes and experiences. Emergent Qualitative Document Analysis (QDA) was used to analyze the responses. Results demonstrated that nurses experienced both positive and negative changes to their sense of calling, sometimes simultaneously. The most frequently cited reasons for positive changes were nurses' perceived job significance, their desire to serve humanity, and a sense of meaningful work. In contrast, terms describing their reasons for experiencing negative changes include exhaustion, underpaid, unappreciated, overwork, disengagement, risky, stress, and anxiety. This study provides the first evidence on how a sense of calling experienced by Turkish nurses has been affected by the COVID-19 pandemic. Implications for theory, research, and practice are explored.

Mental health status of mental health nurses in China: Results from a national survey

INTRODUCTION

It has been acknowledged in China that actions should be taken immediately to ease the critical shortage of psychiatric nurses. However, with national data lacking, little is known about nurses' mental health status.

AIM

To evaluate psychiatric nurses' mental health status by measuring their burnout, depression, anxiety and stress.

METHODS

All psychiatric nurses in the 41 selected hospitals in China were invited to participate in the survey. The Maslach Burnout Inventory-Human Service Survey and Depression Anxiety Stress Scale were used to assess variables of interest.

RESULTS

38.6% of psychiatric nurses met the criteria for burnout. The rates of depression, anxiety and stress were 26.3%, 36.4% and 12.5%, respectively. It was found that workplace region, educational level, working years, longer working hours and night shifts were associated with risk of burnout and DASS.

CONCLUSIONS

More than a quarter of psychiatric nurses are suffering from burnout, depression or anxiety in China. Policymakers and hospital administrators should design a flexible schedule and restrict working hours for psychiatric nurses to achieve work-life balance.

IMPLICATIONS FOR PRACTICE

The study informs policymakers and administrators on addressing the nursing shortage by identifying nurses immersed in negative emotions and preventing mental health problems.

Job Demands, Resources and Burnout Among Polish Nurses During the Late Wave of COVID-19 Pandemic: The Mediating Role of Emotional Labor

Objective

Burnout has been recognized as a serious health problem. Nurses as a professional group are at a high risk of burnout occurrence, especially when facing burden associated with the COVID-19 pandemic. Despite evidence that higher job demands lead to burnout, there is less known about the indirect effect of job demands and resources on burnout via surface acting. Using the JD-R framework, this study examined how job demands and resources affected burnout among Polish nurses and whether these relationships are mediated by surface acting and moderated by coping with the workload.

Materials and Methods

A sample of 270 nurses from the biggest hospital in Southern Poland filled out an online questionnaire at the time between the fourth and the fifth wave of the COVID-19 pandemic in Poland. The Polish adaptations of Oldenburg Burnout Inventory (OLBI), Organizational Constraints Scale (OCS), Interpersonal Conflict at Work Scale (ICAWS), Areas of Worklife Survey (AWS), and Emotional Labor Scale (ELS) were used. Mediation and moderation analyses were carried out in the SPSS macro-PROCESS.

Results

Surface acting partially mediated the positive association between organizational constraints and interpersonal conflict at work and burnout, as well as the negative association between the perceived organizational support and burnout. Coping with workload moderated the direct effect of organizational constraints on burnout via surface acting.

Conclusion

The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between job demands, resources and burnout among nurses. There have been proposed interventions concerning increasing organizational support, effective emotional regulation of management education and psychological training regarding adequate coping strategies which could help reduce or prevent the occurrence of burnout in this professional group.

Relationship between nurse burnout, patient and organizational outcomes: Systematic review

BACKGROUND

Burnout, characterized by emotional exhaustion, depersonalization, and decreased personal accomplishments, poses a significant burden on individual nurses' health and mental wellbeing. As growing evidence highlights the adverse consequences of burnout for clinicians, patients, and organizations, it is imperative to examine nurse burnout in the healthcare system.

OBJECTIVE

The purpose of this review is to systematically and critically appraise the current literature to examine the associations between nurse burnout and patient and hospital organizational outcomes.

DESIGN AND DATA SOURCES

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. PubMed, CINAHL, PsychInfo, Scopus, and Embase were the search engines used. The inclusion criteria were any primary studies examining burnout among nurses working in hospitals as an independent variable, in peer-reviewed journals, and written in English. The search was performed from October 2018 to January 2019 and updated in January and October 2020.

RESULTS

A total of 20 studies were included in the review. The organizational-related outcomes associated with nurse burnout were (1) patient safety, (2) quality of care, (3) nurses' organizational commitment, (4) nurse productivity, and (5) patient satisfaction. For these themes, nurse burnout was consistently inversely associated with outcome measures.

CONCLUSIONS

Nurse burnout is an occupational hazard affecting nurses, patients, organizations, and society at large. Nurse burnout is associated with worsening safety and quality of care, decreased patient satisfaction, and nurses' organizational commitment and productivity. Traditionally, burnout is viewed as an individual issue. However, reframing burnout as an organizational and collective phenomenon affords the broader perspective necessary to address nurse burnout. Tweetable abstract: Not only nurse burnout associated w/ worsening safety & quality of care, but also w/ nurses' organizational commitment and productivity. Reframing burnout, as an organizational & collective phenomenon is necessary.

Quality of Work Life and Contribution to Productivity: Assessing the Moderator Effects of Burnout Syndrome

This study is focused on assessing the effects of burnout as a moderator of the relationship between employees' quality of work life (QWL) and their perceptions of their contribution to the organization's productivity by integrating the QWL factors into the trichotomy of (de)motivators of productivity in the workplace. The empirical findings resulting from an OLS multiple regression, with interaction terms, applied to a survey administered at 514 employees in 6 European countries, point out two important insights: (i) QWL hygiene factors (e.g., safe work environment and occupational healthcare) positively and significantly influence the contribution to productivity; and (ii) burnout de-motivator factors (that is, low effectiveness, cynicism, and emotional exhaustion) significantly moderate the relationship between QWL and the contribution to productivity. Combining burnout with other QWL components, such as occupational health, safe work, and appropriate salary, new insights are provided concerning the restricting (i.e., low effectiveness and cynicism) and catalyzing (emotional exhaustion) burnout components of contribution to productivity. These findings are particularly relevant given the increased weight of burnout, mental disorders and absenteeism in the labor market, affecting individuals' quality of life and organizations' performance and costs.

The association between nurses' burnout and objective care quality indicators: a cross-sectional survey in long-term care wards

Background

Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan.

Methods

This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators.

Results

Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019).

Conclusions

Staff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

Psychometric Evaluation of Stress in 17,414 Critical Care Unit Nurses: Effects of Age, Gender, and Working Conditions

Recent events regarding the COVID-19 pandemic have demonstrated the importance of healthcare workers around the world and the stressful working conditions that are often associated with their profession. The severity of stress can be influenced by a number of factors such as age, seniority gender, family status, and position in the wards. Thus, it is important to monitor signs of stress and other psychiatric symptoms in order to understand the mediating factors and guide appropriate interventions. Here, we describe a cross-sectional study of 17,414 nurses from 31 Iranian cities carried out from 2011 to 2015, using a 22-item tool of work stressors. The tool examined interactive, managerial, and situational domains and the main objective was to identify the main background variables associated with the stress of nurses in critical care settings.

Impact of Workplace Climate on Burnout Among Critical Care Nurses in the Veterans Health Administration

BACKGROUND

Burnout is a maladaptive response to work-related stress that is associated with negative consequences for patients, clinicians, and the health care system. Critical care nurses are at especially high risk for burnout. Previous studies of burnout have used survey methods that simultaneously measure risk factors and outcomes of burnout, potentially introducing common method bias.

OBJECTIVES

To evaluate the frequency of burnout and individual and organizational characteristics associated with burnout among critical care nurses across a national integrated health care system using data from an annual survey and methods that avoid common method bias.

METHODS

A 2017 survey of 2352 critical care nurses from 94 sites. Site-level workplace climate was assessed using 2016 survey data from 2191 critical care nurses.

RESULTS

Overall, one-third of nurses reported burnout, which varied significantly across sites. In multilevel analysis, workplace climate was the strongest predictor of burnout (odds ratio [OR], 2.20; 95% CI, 1.50-3.22). Other significant variables were overall hospital quality (OR, 1.44; 95% CI, 1.05-1.99), urban location (OR, 1.93; 95% CI, 1.09-3.42), and nurse tenure (OR, 2.11; 95% CI, 1.44-3.10). In secondary multivariable analyses, workplace climate subthemes of perceptions of workload and staffing, supervisors and senior leadership, culture of teamwork, and patient experience were each significantly associated with burnout.

CONCLUSIONS

Drivers of burnout are varied, yet interventions frequently target only the individual. Results of this study suggest that in efforts to reduce burnout, emphasis should be placed on improving local workplace climate.

Working Excessively and Burnout Among Nurses in the Context of Sick Leaves

INTRODUCTION

Nurses are particularly at risk of being affected by professional burnout because of the unique patient - caregiver relationship, which requires strong emotional involvement.

AIM

In this study, we decided to examine the mutual correlations of working excessively and burnout - two basic occurrences affecting the mental well-being of employees - and their relationship with sick leave.

MATERIALS AND METHODS

The study was conducted among 460 nurses working in 3 hospitals in Poland. The polish version of Maslach Burnout Inventory and the Working Excessively Questionnaire developed by Paluchowski were used to conduct the survey. All the demographic data and data on sick leaves were obtained from surveys in the form of respondents' self-reports.

RESULTS

The constructed regression model shows that the tendency to work excessively, as assessed by loss of control over work (LCW), perfectionist work style (PWS), and perceived oppressiveness of the organization (OOP) measures, explains 12.4% of the variation in burnout levels. This confirms that overburden with work can be a factor contributing to the increase in burnout measures. The constructed logistic regression model showed that increase in the level of occupational burnout by 1 point, the chance of nurse having at least three sick leaves per year increases 1.029 times (i.e., by about 2.9%). None of working excessively measures affected the frequency of sick leaves.

CONCLUSION

(1) Excessive workload increases burnout symptoms, which in turn encourages nurses to take sick leave more frequently. (2) The tendency for nurses to overburden themselves with work may be seen by hospital managers as a positive phenomenon, but, based on this study, it is clear that this can only be done in the short term, whereas in the long term it will be clearly detrimental to the organization of hospitals and the quality of care.

Burnout among healthcare providers in the complex environment of the Middle East: a systematic review

BACKGROUND

Burnout is a syndrome characterized by emotional exhaustion, increased depersonalization, and a diminished sense of personal accomplishment due to chronic emotional stress at work. Burnout impacts job satisfaction, job performance, vulnerability to illnesses, and interpersonal relationships. There is a gap in the systematic data on the burden of burnout among healthcare professionals from different sectors of healthcare in Middle Eastern countries. Our objective was to examine the burden of burnout among healthcare providers in the Middle East, how it was assessed, which sectors were included, and what interventions have been used.

METHODS

Articles were found through a systematic review of search results including PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO) using search terms reflecting burnout in Middle Eastern countries among populations of healthcare providers. Studies were included if they examined a quantitative measure of burnout among healthcare providers in the Middle East.

RESULTS

There were 138 articles that met our inclusion criteria for this systematic review. Studies focused on burnout in the Middle East among physicians (N = 54 articles), nurses (N = 55), combined populations of healthcare workers (N = 22), and medical students (N = 7). The Maslach Burnout Inventory was the most common tool to measure burnout. Burnout is common among physicians, nurses, and other healthcare professionals, with prevalence estimates predominantly ranging between 40 and 60%. Burnout among healthcare providers in the Middle East is associated with characteristics of their work environments, exposure to violence and terror, and emotional distress and low social support.

CONCLUSIONS

Burnout is highly prevalent among healthcare providers across countries in the Middle East. Previous studies examining burnout in this region have limitations in their methodology. More thoroughly developed epidemiologic studies of burnout are necessary. Health system strengthening is needed in a region that has endured years of ongoing conflict, and there is an urgency to design and implement programs that tackle burnout among health professionals.

Relationship between occupational burnout and demographic variables among nurses in Jahrom, Iran

Introduction

Occupational burnout is a psychological syndrome caused by the accumulation of work-related stress and characterized by intolerance, high levels of emotional exhaustion, depersonalization, and the perception of low personal accomplishment. The present study aimed to evaluate the relationship between occupational burnout and all demographic variables among the nurses in Jahrom, Iran.

Methods

The present descriptive-analytical study was carried out during 2016 among nurses employed at Motahari Hospital and Peymanieh Hospital, both affiliated to Jahrom University of Medical Sciences (Iran). Based on the inclusion criteria, a total of 250 participants were selected. The data collection instruments included a demographic questionnaire and the Maslach burnout inventory. The data were analyzed using the SPSS statistical software (version 16.0) by descriptive statistics and Spearman's test.

Results

Among the participants, 223(89.2%) nurses suffered from a moderate to high level of occupational burnout. There was a significant correlation between personal accomplishment and age (r=0.21, P=0.002) and education level (r=-0.16, P=0.01). Additionally, income level had a significant correlation with emotional exhaustion (r=-0.38, P=0.001), depersonalization (r=-0.3, P=0.001), and personal accomplishment (r=0.35, P=0.001). A significant relationship was also found between sex and depersonalization (r=-0.15, P=0.02). However, there was no significant relationship between occupational burnout subscales and the number of children, type of hospital ward, type of employment, and marital status (P>0.05).

Conclusion

A significant positive correlation was found between the subscales of occupational burnout and younger age, low income, high education, and male nurses.

The effects of amplitude and stability of circadian rhythm and occupational stress on burnout syndrome and job dissatisfaction among irregular shift working nurses

AIM

To investigate the relation between the circadian rhythm amplitude and stability, and occupational stress with burnout syndrome and job dissatisfaction among shift working nurses.

BACKGROUND

Irregular shift working nurses are prone to burnout syndrome (BS) and job dissatisfaction (JD). circadian rhythm difference and occupational stress might be effective in causing burnout syndrome and dissatisfaction.

DESIGN

In total, 684 nurses who worked in four teaching hospitals were selected by stratified random sampling in a cross-sectional design based on STROBE guidelines.

METHODS

The data were collected by the Circadian Type Inventory, Job Content Questionnaire, Minnesota Satisfaction Questionnaire and the Maslach Burnout Inventory. Multiple linear regression, one-way ANOVA and independent t test were used for statistical analysis by SPSS v24.

RESULTS

About 15% of the nurses suffered from high levels of burnout syndrome. Psychological demand (β = 0.022, CI 95% = 0.003-0.047 and β = 0.016, CI 95% = 0.001-0.032) and workplace support (β = -0.043, CI 95% = -0.097-0.003 and β = -0.025, CI 95% = -0.046-0.006) were significant predictors of BS and JD. Male nurses reported lower BS and higher JD compared to female nurses. Irregular shift working schedule was also related to a significantly higher odd of BS (p = 0.009) and JD (p = 0.011). Nurses classified as languid experienced significantly more BS and JD than vigorous nurses.

CONCLUSION

This study shows that BS and JD were strongly associated with psychological demand and workplace support; and vigorous nurses were less prone to BS and JD, and were more suitable for irregular shift work.

RELEVANCE TO CLINICAL PRACTICE

In order to reduce burnout syndrome and job dissatisfaction among irregular shift working nurses, we need to identify the effect of risk factors such as individual differences on the circadian rhythm and job demand which can affect nurses who work in irregular schedules.

Factors associated with and impact of burnout in nursing and residential home care workers for the elderly

Background and aim of the work: Numbers of elderly people worldwide continue to grow. Increasingly these individuals require nursing and residential care to meet their needs. Nursing is an occupation associated with burnout amongst its workforce, associated with increases of emotional exhaustion, depersonalisation and decreases in personal accomplishment. This review of literature provides a more detailed picture of the associations and predictors of burnout within this setting, and also considers the implications this holds for patient care, before providing recommendations for managers of such settings. Methods: Literature searches were conducted across a range of academic databases with a series of relevant keywords. Results: Examination of search results suggested several factors relating to staff burnout including occupational aspects, types of setting, staff perceptions, coping strategies, education and training and the impact of burnout on care delivery. Conclusions: Studies from across the globe suggest that burnout is prevalent amongst staff working in nursing and residential homes caring for elderly people, with implications for the patients, staff and homecare providers. Factors associated with burnout appear to include perceptions of job stress and occupational aspects, as well as the types of coping mechanisms staff employ. Managing grief associated with death of patients at work, as well as staff perceptions of both clients and their illnesses also appear related to burnout as well as the specific type of healthcare setting.

Effect of Nurses' Emotional Labor on Customer Orientation and Service Delivery: The Mediating Effects of Work Engagement and Burnout

BACKGROUND

The emotional labor performed by organization members affects psychological well-being at the individual level, which consequently affects results at the organizational level. Moreover, despite evidence that the customer orientation and service level of nurses greatly affect hospital management, studies that comprehensively analyze emotional labor, work burnout, and work engagement related to customer orientation and service level are lacking. This study investigated relationships and paths by designing a model of the effect of emotional labor performed by nurses on the level of service delivery and customer orientation.

METHODS

This survey-based study was based on a path analysis designed to verify a hypothesized model involving emotional labor performed by nurses, level of service delivery, customer orientation, work engagement, and burnout. Questionnaires were distributed to 378 nurses in general hospitals with more than 500 beds located in Seoul, Republic of Korea, between March 25 and April 8, 2013.

RESULTS

The results showed that deep acting and work engagement had direct and indirect effects on increasing the level of service delivery and customer orientation of nurses. However, surface acting had an indirect effect on reducing the level of service delivery and customer orientation.

CONCLUSION

It would be more effective to develop interventions to enhance deep acting and work engagement than to attempt to reduce surface acting and work burnout in clinical nursing settings.

Prevalence of burnout among nurses in Iran: a systematic review and meta-analysis

AIM

This study aimed to summarize the available information in the literature to make an accurate estimate of the prevalence of burnout among Iranian nurses.

BACKGROUND AND INTRODUCTION

Burnout is a work-related stress syndrome that has negative impact on healthcare providers, patients and healthcare delivery systems.

METHOD

A comprehensive search of literature using international [PubMed, Scopus and the Institute for Scientific Information (ISI)] and Iranian scientific data bases [Scientific Information Database (SID), IranMedex and Magiran] was conducted to identify English and Persian language studies, published between 2000 and 2016, that examined the prevalence of burnout among nurses in Iran. The I-squared test and Chi-squared-based Q-test suggested heterogeneity of reported prevalence among the qualified studies; thus, a random-effects model was applied to estimate the overall prevalence of burnout among nurses in Iran.

RESULTS

Based on 21 selected articles with 4180 participants, the overall prevalence of burnout among Iranian nurses was estimated to be 36% [95% confidence interval (CI), 20-53%] in Iran. Meta-regression indicated that sample size and year of data collection, mean age of samples, female to male ratio and geographic regions were not statistically significantly associated with the prevalence of burnout. Also, based on Egger's test and funnel plot, there is no publication bias among studies included in the analysis.

CONCLUSION

Professional burnout affects more than one-third of nursing staff in Iran; thus, effective interventions and strategies are required to reduce and prevent burnout among nurses.

IMPLICATION FOR NURSING AND HEALTH POLICY

Due to the negative consequences of burnout on patients, nurses and organizations, nursing and healthcare managers should intervene to prevent and reduce burnout among nurses in Iran. Policy attention should focus on developing effective interventions to prevent and minimize the burden of burnout among nurses in Iran. Nurses' involvement in the policy-making process is crucial in the implementation of effective programs and initiatives tailored to address the higher prevalence of burnout among Iranian nurses.

Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

BACKGROUND

Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.

OBJECTIVES

To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.

METHOD

Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).

RESULTS

The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.

CONCLUSION

Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Comparison of Nurses in Two Different Cultures: Who Experiences More Burnout

PURPOSE

Although burnout occurs in almost all occupational groups, it is mostly observed in professions requiring face-to-face relationships with people, especially among health care workers who deal constantly with problems and expectations of people.

DESIGN

The objective of this study was to determine the burnout levels of nurses working in surgical clinics in two countries.

METHODS

This descriptive study was conducted between June and September 2013. The study's population consisted of 179 nurses working in the surgical clinics of Ataturk University Research Hospital and Iran Urmiyili Shahidmotahari University Hospital. A questionnaire involving descriptive characteristics of nurses and the Maslach Burnout Inventory were used to collect the data.

FINDINGS

Nurses working in Turkey had higher mean scores of "emotional exhaustion" and "depersonalization," and a higher mean composite score. Nurses working in Iran had higher mean scores of the subscale "personal accomplishment." Although there was a statistically significant difference between both countries in terms of emotional exhaustion and personal accomplishment (P < .05), there was no statistically significant difference between them in terms of mean score of depersonalization and total mean composite score of the inventory (P > .05).

CONCLUSIONS

Nurses working in Turkey experienced more emotional exhaustion and less personal accomplishment compared with nurses working in Iran. In line with this result, improvements in their work environment and conditions are recommended to provide organizational support by fostering job satisfaction, preventing exhaustion by arranging shifts based on workload, and offering psychological counseling services to employees.

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

Background:

Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future.

Methods:

We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey.

Results:

We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels.

Conclusion:

As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

Systematic Review of Mindfulness Practice for Reducing Job Burnout

OBJECTIVE

A systematic search and critical appraisal of interdisciplinary literature was conducted to evaluate the evidence for practicing mindfulness to treat job burnout and to explore implications for occupational therapy practitioners.

METHOD

Eight articles met inclusion criteria. Each study was assessed for quality using the Physiotherapy Evidence Database scale. We used the U.S. Agency for Health Care Policy and Research guidelines to determine strength of evidence.

RESULTS

Of the studies reviewed, participants included health care professionals and teachers; no studies included occupational therapy practitioners. Six of the 8 studies demonstrated statistically significant decreases in job burnout after mindfulness training. Seven of the studies were of fair to good quality.

CONCLUSION

There is strong evidence for the use of mindfulness practice to reduce job burnout among health care professionals and teachers. Research is needed to fill the gap on whether mindfulness is effective for treating burnout in occupational therapy practitioners.

Motivating factors among Iranian nurses

BACKGROUND

One of the most important challenges of Iranian health care system is "quality of care," and it is assumed that motivated nurses are more ready to provide better care. There are limited studies investigating Iranian nurses' motivations; however, factors which motivate them have not been studied yet. Identifying the motivating factors enables nurse managers to inspire nurses for continuous quality improvement. The aim of this study was to identify motivating factors for Iranian hospital nurses.

MATERIALS AND METHODS

This is a cross-sectional descriptive study in which 310 nurses working at 14 hospitals of Tehran University of Medical Sciences were selected by proportionate stratified random sampling. Data were collected in 2010 by a researcher-developed questionnaire. Descriptive statistics and independent t-test, analysis of variance, Tukey post-hoc test, Chi-Square and Fisher's exact test were used for statistical analysis by Statistical Package for Social Sciences (SPSS) version 16.

RESULTS

The mean score of motivation was 90.53 ± 10.76 (range: 59-121). Four motivating factors including "career development" (22.63 ± 5.66), "job characteristics" (34.29 ± 4), "job authority" (18.48 ± 2.79), and "recognition" (15.12 ± 2.5) were recognized. The least mean of the motivation score, considering the number of items, was 3.23 for career development, while the highest mean was 3.81 for job characteristics.

CONCLUSIONS

The findings showed that motivation of nurses was at a medium level, which calls for improvement. The factors that have the greatest potential to motivate nurses were identified in this study and they can help managers to achieve the goal of continuous quality improvement.

Staff Burnout--a Comparative Study of Metropolitan and Rural Mental Health Nurses within Australia

This article will present the findings of a research study that investigated the extent to which mental health nurses employed within rural and metropolitan areas of Australia are affected by burnout, using the Maslach Burnout Inventory (MBI) and a demographic questionnaire. The study also examined whether the Maslach Burnout Inventory (MBI) was a valid measure of mental health burnout within the Australian context and culture or alternatively, in what ways it needed to be refined? A cross-sectional study of mental health nurses (n  =  319) from the states of New South Wales, Victoria, Queensland and Western Australia was undertaken. The 22-item Maslach Burnout Inventory (MBI) was used to measure burnout and a demographic questionnaire utilising a cluster sampling, cross-sectional design survey method, was used to gather the data. The study found that gender and level of qualification were the two major factors that showed any significance, where males experienced a higher level of depersonalisation on the frequency and intensity sub-scale scores of the MBI and that the more qualified a nurse, the greater the level of depersonalisation they experienced. These results were true for participants in both rural and metropolitan settings within Australia. Age was the third most influencing factor in terms of emotional exhaustion, where younger participants (under 30) reported higher levels of emotional exhaustion. Younger male mental health nurses experienced higher levels of depersonalisation.

Relationship between ICU nurses’ moral distress with burnout and anticipated turnover

Background:

Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important.

Research objective:

The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses.

Research design:

This study is a descriptive-correlation research.

Participants and research context:

A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19.

Ethical considerations:

Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran.

Findings:

The findings showed intensive care unit nurses’ moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses’ age, their work experience and the fraction of nurses’ number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress.

Discussion:

Some of the findings of this research are consistent with other studies and some of them are inconsistent.

Conclusion:

Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses’ moral distress, burnout and their turnover intention are essential.

Compassion fatigue and satisfaction: a cross-sectional survey among US healthcare workers

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self-report instrument in a community hospital in the United States. A cross-sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.

A systems perspective on nursing productivity

PURPOSE

Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience.

DESIGN/METHODOLOGY/APPROACH

An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper.

FINDINGS

It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the "productive ward" and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge-intensive health organisations.

PRACTICAL IMPLICATIONS

Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated.

ORIGINALITY/VALUE

The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.

Psychological well-being of Thai nursing students

BACKGROUND

The psychological well-being of nursing students is a very important component in the training and development of future nurses. While previous studies have explored different aspects of nursing students' mental and psychological health in various countries, they have given little attention to comparing nursing students with their non-nursing student peers. The present study investigated the differences between nursing students and non-nursing students in Thailand with regard to their psychological well-being. The gender effect was also examined.

METHOD

Four hundred students were included in this study (200 nursing students and 200 non-nursing students). Participants completed a demographic questionnaire and four psychological instruments that examined their self-esteem, life satisfaction, depression, and social difficulties.

RESULTS

Overall, compared to their non-nursing counterparts, nursing students were found to score significantly higher on self-esteem and life satisfaction and reported lower levels of depression and social difficulties. Gender was also found to have a significant main effect on participants' social difficulties. Several recommendations for improving the mental health and psychological well-being of nursing students are discussed.