Prevention of Burnout Among Nursing Staff: a literature review
Burnout in nursing staff is a major cause of turnover and absenteeism. The term “burnout” was first coined by Freudenberger in 1974 (Jennings, 2008). This term is used to describe a worker’s reaction to chronic stress and is common in occupations involving multiple interactions with people (Hughes, 2008). According to Maslach and Jackson, “the burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment.” It has been associated with working conditions in nursing. The topic of burnout has been studied a lot and is still being studied today as it is considered an epidemic across the world. This paper will focus on how stress can lead to an increase in nurse burnout in the critical care setting where nurse burnout remains to be a significant problem.
Several online databases were accessed to obtain literature for this review: Academic Search Premier, CINAHL Complete, EBSCO MegaFILE, Health Source: Nursing/Academic Edition, and PsychARTICLES. The articles’ publication dates range from – to – and are limited to scholarly, peer-reviewed academic journals. These databases were accessed through the Augustana University Mikkelsen Library website. The search terms used when searching for articles included nursing, prevention, burnout, and literature review.
According to Jennings, stress is categorized as an “antecedent or stimulus, as a consequence or response, and as an interaction” (2008). Stress is an individual response. Everyone gives their own perceptions and interpretations to whether situations are threatening (bad stress) or positive (good stress). It is defined as a “state of disequilibrium that occurs when there is a disharmony between demands occurring within an individual’s internal or external environment and his or her ability to cope with those demands” (Townsend & Morgan, 2018). This ties into nursing burnout as the nurse’s role has long been regarded as “stress-filled based upon the physical labor, human suffering, work hours, staffing, and interpersonal relationships” that are central in all that nurses do (Jennings, 2008, p. 2137).
Phases of Stress
The human bodies are able to survive in a given environment since they can maintain the balance or homeostasis that is constantly challenged by intrinsic or extrinsic factors, called stress factors. Any events that an individual perceives as threatening or dangerous can be considered a stress factor or a stressor (Matos AS, Jacome JC (1998) Stress. Psycho Anal 4: 691-698). Stress can be subdivided into three phases: the alert, resistance, and exhaust.
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The alert stage of is when the individual is the source of stress. This causes an internal unbalance which can present in symptoms such as excessive sweating, tachycardia, body breathless, and hypertension peaks. The primary function of the alert stage is to bring together all the features of the body. This function is done in order to prepare the body to face the stressor. However, if the stressor is extremely strong it can cause death.
The second stage is the phase of resistance. It is characterized by a recovery attempt of the imbalance suffered in the initial phase. Symptoms that may arise in this phase are excessive fatigue, memory problems or even doubts in relation to the stress due to the expense of existing energy. The stressor agent remains active but is no longer strong enough to cause the death of the individual. During this stage, the body will try to adapt to what caused stress and will try to reduce or eliminate the stress. If the body is unable to reestablish a balance, this process can continue to build and reach the third phase, the phase of exhaust ventilation.
The phase of exhaust ventilation is when the stressful factor progressively weakens the immune system and eventually overwhelms the energy reserves are depleted. This stage can bring back the symptoms or alarm. However, the symptoms are now irreversible which will cause the individual to have a high degree of physical impairment and may even build up to death. This phase includes a partial phase called an almost-exhaustion. It is called this because it is a recovery phase. Here the individual does not manage to adapt to the stressor which in turn causes the productivity of the individual to be compromised.
Consequences and symptoms of stress
High levels of stress may negatively affect the physical and emotional welfare of individuals. This can generate problems of social adjustment, family, professional, and health (1). Some symptoms that are easily perceived and linked to stress are accelerated breathing, palmar sweating, tachycardia, headache, nausea and vomiting, fatigue, stomach and chest pains, irritation, and excessive gastric acidity. Others that are not as easy to notice are difficulty in interpersonal relationships and disinterest for various activities (1). Stress can often by linked to the origin of some pathologies, such as arterial hypertension, decrease of the gums, psoriasis, lupus, obesity, cancer, depression, anxiety, and psychotic episodes (1). Regarding consequences of stress, you can have an effect on the professional level. This can be seen in a decrease in productivity, relationship problems, delay and low performance (1).
Benefits of Stress
The harmful effects of nurse burnout are no secret. As much as nurses see themselves as invincible they are not immune to the damage of workplace stress can bring. According to Khamisa, Peltzer, and Oldenberg (2013), nurses experience higher burnout rates than other healthcare professionals. This burnout can be caused by staff shortages, long shifts, heavy work load, time constraints, the emotional toll of exposure to suffering, a high-energy work environment which values productivity over personalization, and many other aspects of the job (Gautheir, Meyer, Grefe, & Gold, 2015; dos Santos et al., 2016).
The burnout has been referred to as one of the areas of negative impact on the well-being, the physical and mental level, in health care professionals. The term implies burn something to exhaustion, ie. until it is consumed throughout the power available (Maroco, Maroco, Leite, Bastos, Vazao, & Campos, 2016). The Burnout syndrome can be characterized as a self-perceiving the emotional exhaustion, lack of professional success of the individual and depersonalization (Trindade & Lauterte, 2010 and Maroco et al, 2016). This syndrome affects individuals of any age ranges who are in any professional category. However, those who are usually affected by this disorder are typically involved in some kind of interpersonal contact. This syndrome includes emotional exhaustion, depersonalization and lack of professional achievement by the individual worker (Trindade & Lauterte, 2010). The most basic point of stress in this syndrome is emotional exhaustion.
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Burnout Syndrome is multiclausal (involving individual and labor factors. The emotional exhaustion is due to a load of bidirectional work that involves the care of home and the performance of professional life (Trindade & Lauterte, 2010). The individual initially feels tired and has an enormous difficulty in dealing with the emotions of others. This can lead to problems in dealing with those who are sick. These individuals can be viewed as cold and disinterested in others (Maroco et al, 2016). Other factors that can lead to emotional exhaustion is the lost sense of vocation, the attempt to conserve an image of himself and/or herself, and the search for the realization of the social and personal level. These behaviors relate to stress and occur with exhaust ventilation (Costa & Pinto, 2017). When exhaust ventilation initially occurs, the professional has the feeling of loss of vitality joint with a feeling of discouraged workers. This installs the feelings of indifference, leading to boredom, as well as deconcentration and disorientation. All these feelings that tie back to exhaust ventilation can be triggered by the feeling of not achieving something that they once could. The consequences of this lead to absenteeism with or without justification, lateness to work or change in working, and low efficiency levels (Costa & Pinto, 2017). Depersonalization usually occurs because the individuals are subject to pressures and demands on the part of society.
The burnout may be accompanied by many symptoms and distressing feelings. First, can arise feelings such as loss of vitality and the hopelessness, staying after the indifference, the boredom, the cynicism, as well as the disorientation and deconcentration. Other burnout symptoms of burnout can be classified as physical and psychological symptoms. Physical symptoms are insomnia, lack of energy, back pain, loss of appetite, ulcer, migraine, and nausea. Psychological symptoms are cynicism, irritability, denial of failures, loss of the sense of humor, indifference, insecurity, disinterest, indecision, reduction of self-esteem, and loss of memory (Costa & Pinto, 2017). The prevention for Burnout Syndrome (or for stress) requires the individual and workers to revise certain values and concepts (Maroco, Maroco, Leite, Bastos, Vazao, & Campos, 2016).
Background of Nurse Burnout
Stress is a theme that has been the target of a variety of studies. Stress is defined as a state of mental or emotional strain or tension resulting from adverse or demanding circumstances Stress is coined to the term fear, which is defined as an unpleasant emotion cause by the belief that someone or something is dangerous (Townsend & Morgan, 2018). The means of individuals in the work place is based on occupational stress, burnout and coping. It is through these means that individuals are able to achieve self-realization and establish interpersonal relationships. With these relationships came the evolution of labor markets. These labor markets have increased the competitiveness that has put adverse pressure and demands on workers. These transformations can give rise to occupational stress.
Barriers to the Prevention of Nurse Burnout
Benefit of Preventing Nurse Burnout
Jennings explored the effect of stress and burnout among nurses on patient outcomes. Within the studies, Jennings found that nurse burnout is related to increased mortality, failure to rescue, and patient dissatisfaction.
Recommendations for Practice
Based on current empirical evidence on stress and burnout in nursing, there is difficulty in making recommendations regarding how to improve patient safety while decreasing nursing burnout and stress. Findings consistently indicated that nurse burnout was negatively related to job satisfaction. Practice implications are unclear regarding the effect of work stress on nursing staff as the lack of clarity from complexities of the concept. In one study the nurses were grouped into four clusters based on their level of stress, symptoms, burnout, and unit social support. In another the nurse ratings of job strain placed them in four groups from low to high strain. Another focused on the effects of shift length on stress (Jennings, 2008) Some of the main concepts with evidence that accrued throughout the studies was social support and managerial support.
The use of empowerment and support by managerial teams
Evidence is accruing about the utility of empowerment and social support in mitigating stress. Finding related to social support indicated that interpersonal exchanges with coworkers and supervisors may enhance security, mutual respect, and positive feelings (Jennings, 2008). With the use of all these interpersonal exchanges, nurses can have reduced stress which will lead to a decreased nurse burnout rate. However, this evidence was founded on weak conceptualization and relied upon weak instruments to measure the concepts.
Some of the studies found that managerial behaviors were linked to stress and burnout. With the use of participative management, managerial teams can help reduce stress in their workforce. This decrease in burnout and work stress are related to when administrators create work environments that provide staff with access to opportunity, information, resources, and support. These features all link back to the sense of empowerment in the workplace which helps in reduction of stress and burnout.
Stress and burnout are concepts that have sustained the interest of nurses and researchers for decades. These concepts are highly relevant in the workplace. Despite this interest and relevance, the effects of stress and burnout are not well defined by evidence. There is a great need for comprehensive studies that will examine dynamics and yield a more solid evidence on which to base practice.
- Costa, B., & Pinto, I. (2017). Stress, burnout and coping in health professionals: A literature review. Journal of Psychology and Brain Studies, 1(4), 1-8.
- Hughes, R. (2008). Work stress and burnout among nurses: Role of the work environment and working conditions. Agency for Healthcare Research and Qaulity, (26).
- Jennings, B. (2008). Work stress and burnout among nurses: Role of the work environment and working conditions. Patient Safety and Quality: An Evidence-Based Handbook for Nurses, (26), 2137-2148.
- Maroco, J., Maroco, A., Leite, E., Bastos, C., Vazao, M., & Campos, J. (2016). Burnout in portuguese healthcare professionals: An analysis at the national level. Acta Med Port, 29(1), 24-30.
- Trindade, L., & Lautert, L. (2010). Syndrome of burnout among the workers of the strategy of health of the family. Rev Esc Enferm USP, 44(2), 273-278.
- Townsend, M., & Morgan, K. (2018). Psychiatric mental health nursing
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