Burnout of Nurses: Critical Analysis Assessment 2 Answer

INTRODUCTION

The term burnout was first coined by Freudenberger in 1974 for addressing the feeling of build up within professional experiences of the individual. Burnout is the term which is used for the employee whose emotional resources are being depleted. Nurses are susceptible to developing burnouts due to the nature of the work-pressure they are exposed to in their professional role and responsibilities. The nature of the job in nursing demands a lot of emotional and physical strength. In a healthcare system for proper functioning burnout among nurses should be evaluated pertaining to its detrimental affect both personally and professionally. The objective of the paper is to furnish critical review on three of the study done in the subject “ burnout among nurses” and evaluate its effect on them in terms of various parameters namely absenteeism, patient quality care, job dissatisfaction etc. The critical review of these studies is done under certain sections like authorship, design of the study, methodologies adapted by author and result presented through findings

Authorship

Authorship is the critical component of the research paper; it should be in accordance with the knowledge of the subject and analytical approach to facilitate the research (Hundley et al, 2013). An author is liable for the decisions under various sections of the research paper in terms of its aim, objective, hypothesis, study design and ample selection. In a research paper, a clear indication of authors, contributors, acknowledgement and conflict of interest should be presented.

The first study by Weu Yi Tay et al 2019 has authors from the medicinal background.  The primary author is a bachelor’s in medicine and surgery and is working with the department of family medicine and care; other authors also have relevant educational landmarks as per the requirements to process the clinical research in the subject area. All authors have an authentic experience and subject knowledge with credible qualifications. However, none of the authors is from the nursing background or working with the nursing unit in the hospital. This may affect the actualization and realization process of the research study (Matarese&Shashok2019).

Authors in the research study by White et al, 2019 are well qualified to conduct the research study according to norms and regulations (Vanora et al, 2013). Authors are associated with the university for nursing studies hence possess the knowledge of nurse load and their burnouts.  Being from a policy and research in school of Nursing empowers authors to utilize outcome in study for policy formulation.

In the third study conducted by Dyrbyeey et al, 2019 all the authors are with educational background validating their knowledge source required for the topic understanding. One of the authors is working in the department of well being hence could have a better understanding of burnout syndrome in nurses and its effect in terms of emotions and psychological wellbeing. Two of the authors are registered nurses increasing the credibility of the author to conduct a study based on nursing working impact (Matarese & Shashok, 2019).

Research Questions/Aim/Hypothesis

In a research study, a primary question within the study should be derived from the hypothesis but not the data. That is a well-thought research study hypothesis and research question is developed before initiation often research study ( Ratan et al, 2019)  therefore a good hypothesis it the one which is based on the research question. And should derive questioner development and data collection of the study, hence it is the intuitive process.

The study conducted by Dyrbye et al, 2019 has the title “A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses”, title of the study is clearly indicative and precise. The research question has been established by the author in the abstract where he suggests a higher prevalence of the burnout among users. In the background section of the research need of the study has been established clearly where the author states that many previous studies have suggested the burnout in  nurses evidently and may results in job dissatisfaction, however, few studies have studied the impact of burnout in terms of absenteeism and work experience (Moghaddasi et al, 2013). The statement by the author establishes the gap in the literature available with the need of the new study n the subject. Although author has extensively mentioned the studies published under the similar topic, most of the studies mentioned are older in term of years of their publications. So the author might have missed on the later developments which can influence the need to gap identification. The author clearly hypothesised that nurses who have the burnout are more likely to be absentee and have lower job performance in comparison to non-burnout nurses (Zeng et al, 2020). In the abstract and background section author has extensively established the research question, hypothesis and study need in terms of the gap in literature but no information on Aim and objective is furnished by the author.

In a study conducted by White et al, 2019 aim and objective are clearly mentioned by the author. The objective is to examine the relationship between the registered nurse burnout, job dissatisfaction and care quality in the nursing homes. In the introduction section, the research question has been demonstrated where the author addresses the relationship between the work environment and patient safety outcomes suggestive supportive work environment to ensure safe care by the nurses. The author also states that the relationship is not clearly understood in the set up of nursing homes.  Literature review done by the author indicates that lower staffing, the climate of the workplace, higher stress at work and poor teamwork contribute toward the missed care by nurses, however, authors mentions the absence of studies which measures the specific task of licensed nurses like medication administration, educating family, treatment protocols etc. Hypothesis has been stated by the author as burnout and job satisfaction both was being associated with missed care in the nursing homes. However, this section has several strengths in terms of aims and objective, hypothesis demonstration but missed on establishing the gap in the literature. The author has presented scarce literature to which he justifies the absence of such studies in his country. This makes the need for the study less justifiable.

In a study by Tay et al, 2019 abstract establishes the need as well as the research question, in introduction author has mentioned burnout a the significant issue in the healthcare industry which has negative implications on the clinical outcomes. However, the author mentions that no such study has been conducted in community hospitals in the country. This identifies the need of the study appropriately. Although the author has mentioned that several studies have been conducted in the similar subject outside his country, no further explanation or detailed review of these studies were found, hence the absence of any systemic review of literature could be a drawback for the study. No discussion of the current studies or previously available data weakens the argument on the need of the study for establishing the study implementations in terms of results and outcomes (Rosenthal et al, 2014). Aim and objective of the research study are mentioned by the author clearly in the abstract itself which states”to analyse the prevalence of burnout among community nurses and explore the factors associated with burnout. Aim of the research is to identify the risk factor associated with the burnouts among nurses. Although the author has mentioned the aim and objective, establishing the research question but absence of clear hypothesis and review of current literature may weaken the section of the research study further questioning the selection of the sample size and study design. 

Research Design

A study conducted by Dyrbye et al, 2019 has been based on the cross-sectional study survey conducted by the author in the year 2016, a survey among the nurses has been done where the demographics, fatigue of the nurses are used to measure the burnout and in turn the absentee and poor performances of the nurses. Authors have mentioned to abiding with strengthening the reporting of observation studied and epidemiology (STOBE) guidelines and methodologies. However, the author has not mentioned why the choice for the study was cross sectional. However, the choice of the study is justifiable as author intend to only observe the effect of burnout of the performance of nurses in terms of absentees, meanwhile, the author hypothesised to establish a relationship between the burnout, absentees among nurses and their poor job performance.  Cross-section studies are those studies where the investigator has the sole purpose of measuring the outcome and exposure during the research study in the same period. As the author has used a national anonymous survey the choice of the study seems rationale. Cross sectional study deign are done on the population based sample to assess the prevalence of a condition among them. However in cross-sectional studies the author should have discussed the exclusion inclusion criteria, which is quite essential in the cross-sectional studies (Cishahayo et al, 2017). Despite being prime importance criteria for selection seems vague.

A study by White et al also has the cross-sectional secondary analysis based o the survey conducted from the period of one year that is January to December in 2015. The choice of study is appropriate as author’s prime objective to identify the relationship between the nursing factor contributing toward burnouts and the care quality within the healthcare setting. The author does not intend to provide interventions to them and measure the changes after interventions, so a simple choice of design could be cross-section, however, the comparative analysis could have been done using the two study group to validate the comparative results establishing the presence of conditions that is burnout and quality care more significantly and strongly.

Tay et al, 2014 adopted the cross-sectional study design using the self-administered and anonymous questionnaire. The Author has mentioned regarding the approvals from the centralised institutional review board, this increases the confidentiality and authenticity of the participants and their responses. The study was conducted for one month. The choice of study is coherent as author target to observe the prevalence of burnout among community nurses in the hospital settings. However, the author has not explained the sequential structure of the design further and how the sample size was selected. The author has mentioned regarding the pecularity of the community hospitals where the study was being conducted, he stated that the this was the only hospital that provides the inpatient palliative care and the rehabilitation care to the patients chronically sick, this may add to the distinctiveness of the study however author has not mentioned what could be the uniqueness of possible variable exposure of such hospital set up.

Research Methods

Author Dybre et al in the study has taken a random sample size of 3150 nurses all across the nation, registered nurses were only considered for the interview. The author has used an extensive method of emailing the nurses through the database. Participation was voluntary and anonymous, only nurses with an associate degree were accounted; author excluded the advance practice nurses due to the broader scope of practice and varied nature of responsibilities. However the author has mentioned the methods and criteria for sample size, it could have been precise, and methods of interviewing seem indeterminate. Questions of the survey have been divided into demographical information, practice characteristics and instruments to measure the absenteeism. The strength of the research paper seems to be the questionnaire where the author has extensively mentioned details of nature and type of questions and information he tried to derives from it (Munnangi & Boktor,2020). Questions are described concerning age, gender, relationship, working hours, marital status, work-life balance, work performance, fatigue, depression etc. To measure absenteeism a standard questionnaire has been used by the author as recommended by World health organisation health and Work performance questionnaire. This elevates the quality of the response and declares the result being undisputed from bias.

Questions were tested based on reliability and validity. For measuring burnout MBI human services survey was considered which includes emotional exhaustion, depersonalization and low esteem with personal accomplishment (Anglemyer et al, 2014). Symptoms of depression have been identified using the primary care evaluation of mental disorder. Statistical analysis is conducted using the descriptive concepts. Variable are evaluated on the basis of Fisher exact or Chi-square test with the use of multivariable analysis to identify associations. A detailed explanation of standard criteria with the precise questionnaire is the anchor of the research study which justifies the results and finding of the study to the minimum error, however, the author has limited the discussion of the statistical technique with no further explanations of deviations observed.

In a study by White et al, 2019 no significant discussion on the crucial quantifiable components were done. These may include the questions asked, variable targeted and the exclusions and the inclusion criteria of the sample. Total 1540 registered nurse were included in the survey which were contacted through the email.  Nurses have been considered only based on their clinical position and administrative nurses were excluded although obtaining the extensive knowledge through email was quite difficult also administrative nurses could be also burnout or may provide some clinical care to patient hence differentiation of the cohort group seems superficial. The response of the nurses was linked with the employer, although the email survey could nullify the organisational interference asking nurses to provide the employer name and address could hamper the privacy and may result in the biased response. Burnout among nurses was measured using Emotional Exhaustion subscale of the Maslach Burnout Inventory which is a standardized tool for measuring the occupational burnout. Impact of burnout is measured in terms of scores. Statistical analysis was conducted for examining peculiar characteristics of the sample. Mathematical analysis techniques used was robust logistic regression model. Although the author has mentioned the use of software version Stata 15.0 being used however no explanation of other details of statistical calculation was provided. Research method by the study was presented steeply as no discussion of sample size; criteria; questionnaire characteristics and statistical analysis were provided (Setia, 2016).

The third study was conducted in 318 bedded community hospitals, as author aims to observe the effect among community nurses. The survey period was 1 month for March 2012. All inpatient nurses were interviewed as the form was handed over to them personally through the charge nurses who were further advised to register the response in a sealed envelope. The author has also explained the exclusion and inclusion criteria. However, the selection of criteria is broad and trivial. An extensive discussion regarding the questionnaire has been done in the section. The study has included 30 questions with 10 questions intended to measure compassion, satisfaction, burnout and traumatic experience of eth nurses. Each question is further scored as per the Likert scale from 1 to 5 a cut off was prepared. There are certain demographic data which has been considered by the author namely age, gender marital status. Total of 147 questionnaires was distributed and out of which 75, which is the responsive rate of fifty-two per cent were recieved. Although the response rate is well established the sample size taken is small and may affect the implementation of the results and significance of findings. Data was analysed through Stata V11 for calculating the proportion of burnout. For the secondary aim of the study, the author has used a binary logistic regression model.

Result

Results of the study Dyrbye et al, 2019 are described clearly and in detail with the help of graphs. The result is depicted under various headings like demographics, association with the burnout and multivariable analysis etc. The study has found that 1 in 3 nurses were having burnout and burnout may double up the incidence of low performance at work. However, the author has failed to find any of the statistical relationships between the absenteeism and the burnout among nurses. But he has mentioned the prevalence of absenteeism due to personal illness and need of addressing work-related stressors which may contribute towards burnout and low performance. However, the result of the study could be affected through limitation which influences the logical argumentation. The author has mentioned that the response rate was only 27 per cent which is quite lowered for any statistical analysis. Also, the mode of the interview was a national survey which could impose response biases; the variable which has been addressed and hypothesized by the author is limited which may lead to other crucial indicators getting ignored. Also the study time was shorter. These points may affect the applicability and implementation of the study result in a population.

 The result from the study conducted by White et al procured a significant result between the burnout nurses and the quality of patient care in the form of missed care. Nurses with burnout were found to be five-time missing on either care schedule or protocols. However author mentions that in the study results they are not able to find any significant pathway between the nurse burnout, job satisfaction and missed care based on the variables. However during study the author has found a secondary concern about retaining nurses in nursing homes. Limitation of the study included the study design itself which restricts the author from deriving variables relationship. The higher number of the nursing home in the country may affect the generalizability of the study and excluding administrative nurses may result in losing respondent.

The study by Tay et al, 2014 found a 33 per cent burnout prevalence among nurses, however, could not be well established pertaining to only sixty-seven responses. The study also found variables having a higher association with burnouts like working in the rehabilitation centre, number of years in the service, interference from family. However, the study had several limitations in term of study design with lesser response rate only 34 per cent from rehabilitation nurses limiting the generalization of the conclusion.

CONCLUSION

All three studies have suggested a higher degree of burnout among nurses owing to related occupational stress. Nurses serve a vital role in the healthcare system hence need for the proper work environment, resources, support, career pathway, leadership opportunities should be provided to establish quality and efficiency. Although studies have strengths and weaknesses, drawbacks in individual studies can be further utilized to identify the need for a study which could fulfil the gap for future studies conduction.