Burnout Syndrome Among Psychiatric Nurses Proposal

Burnout syndrome is a psychological phenomenon identified by gradual emotional and physical fatigue, including the occurrence of adverse perceptions and attitudes towards work and a decrease in empathic concern towards patients (Alharbi, 2019). It arises due to continuous straining, usually caused by intensive, prolonged involvement with people (Dawood et al., 2017). The World Health Organization recently updated its definition of burnout to a syndrome that occurs as a result of prolonged occupational stress that that has not been properly managed. The following three cardinal symptoms stipulated by the WHO were as follows,

1. Feelings of exhaustion or energy depletion
2. Elevated mental detachment towards one’s job and career.
3. Reduction in professional productivity.

It is estimated that 21 to 61 percent of health care practitioners exhibit signs of burnout (Alharbi, 2019). This is due to the demanding nature of the profession. Factors such as caseload size, workplace climate, and severity of patient symptoms have increased burnout among nurses.

Background

Mental health cases occurrences have been on the rise over the past few decades around the globe and in Qassim city. This translates to an increased requirement of psychiatric nurses to work in health care facilities, such as Qassim psychiatric hospital. The consequential shortage of nurses leads to an increase in the workload each nurse is expected to execute. Psychiatric nurses are most prone to work-related stress since they are primarily in continuous, direct contact with patients (Alharbi, 2019). Their work is demanding and requires their full attention and service for long periods. These working conditions, staff shortage, fatigue, interpersonal conflicts, high work expectations, and lack of personal progress contribute to burnout syndrome.

Burnout adversely affects the efficiency of nurses in their practice. It is a critical issue that needs addressing since it causes severe impacts on nurses including, depression, sleep issues, physical and mental exhaustion, feelings of hate towards responsibilities, and anxiety (Alotni & Elgazzar, 2020). Patient care is also affected since burnout nurses’ ability to function is reduced. They develop memory issues, reduced attention to detail, impaired cognitive function, and vigilance (Gheshlagh et al., 2017). These nurses also lose their motivation to work and are often need to be supervised to perform their duties. There is a need to review the prevalence of burnout syndrome in psychiatric nurses to address this issue. There is, however, not enough researches done on this topic, and none has been done in Qassim city. This study, therefore, aims at establishing the prevalence of burnout among psychiatric nurses in Qassim psychiatric hospital.

Statement of Problem

Burnout syndrome among psychiatric nurses in Qassim city is a critical issue that needs to be addressed. To date, there exists an inadequate amount of studies concerning the prevalence of burnout in psychiatric nurses in Saudi Arabia, and no study was conducted in Qassim psychiatric hospital. Nurses who work in Qassim psychiatric hospital may have some challenges, which might contribute to increasing the level of burnout and then affect the workforce outcomes. Identifying the prevalence of burnout in Qassim psychiatric hospitals is likely to assist decision-makers and organizations in modifying policies and systems, which can help create a healthy work environment. This would also help improve the quality of nurses’ work and healthcare delivery. Therefore, the research would help organizations identify strategies to prevent or reduce burnout. In addition, it would also help organizations to identify the contributing factors of burnout and address them. The result of this research would assist in educating psychiatric nurses in Qassim psychiatric hospital about burnout syndrome.

Literature Review

The welfare of health care practitioners is an essential determinant of the quality of the health care services delivered. Burnout is one of the hindrances of the ability of nurses and medical practitioners, in general, to provide adequate services to health care users (Alotni & Elgazzar, 2020). The psychiatric nursing practice encompasses a considerable amount of psychological and psychosocial stressors. These stressors are responsible for burnout in these nurses compared to nurses in departments such as neonatal and peri-operative.

Many Arab countries have health care systems that are still developing and have not yet attained world-class medical equipment, finances, and government policy. Basic infrastructure, such as transport, communication, and health care facilities to expedite the provision of health care services is also lacking (Noureen et al., 2019). In Saudi Arabia, for instance, most hospitals, including Qassim psychiatric hospitals, record inadequate room in wards to accommodate all admitted patients. Despite a fairly adequate number of qualified nurses in the country and foreign nurses, many local hospitals are understaffed (Alotni & Elgazzar, 2020). The ratio of nurses to patients seeking service in Qassim psychiatric hospital is unproportioned, with nurses required to attend to significantly more patients in a day compared to developed countries (Gheshlagh et al., 2017). This ratio proves the theory that nurses are understaffed and overworked.

Overworking leads to negative physical and psychological ramifications, including depression, crucial family issues, diminished occupational satisfaction, lowered performance, chronic absenteeism, and eventually quitting of work. Burnout has also been attributed to deteriorating medical professionals’ physical health, causing anxiety, cardiovascular disorders, loss of motivation, physical fatigue, and depression (Noureen et al., 2019). The health system organization is also interrupted by interpersonal conflicts among health care workers caused by burnout. Psychiatric and intensive care units are the two departments most affected by burnout (Gheshlagh et al., 2017). These sectors demand a high level of involvement of nurses in attending to patients. Nurses, being the forefront, and most immediate responders, are tasked with providing care to these patients who often require prolonged and constant monitoring.

Search strategy

A systematic search evaluated studies published within the last five years using PubMed, Google Scholar, and PsycINFO databases. The keywords used during the search were “burnout syndrome,” and “psychiatric nurses,” and “psychiatric hospitals.” The total number of studies obtained from the first round of the search was 3,510. From these articles, those not published in English were excluded from the search, while those published in English were included. The articles written in English were then evaluated using their titles, abstracts, and full text. The search then excluded those studies that focus primarily on psychiatric nurses. Since burnout syndrome is a work associated disease, the search also excluded the theories that focused solely on personal factors such as age and gender. With the exclusion and inclusion criteria, six studies were ultimately identified.

Categories of Burnout

Burnout can be categorized into three variations including,

1. Emotional exhaustion (EE) – overstretch of emotional expression leading to strain in personal and professional life.
2. Depersonalization (DP) – a reduced sense of personal and professional accomplishments.
3. Personal accomplishment (PA) – inability to sustain work and diminished self-motivation.

The Quality of Existing Literature and Research Gap

Previous research has covered chiefly burnout’s causes, risk factors, and effects on healthcare practitioners. Studies carried out in England, Germany, Scotland, Canada, and the United States have lightly explored the prevalence of burnout syndrome in healthcare professionals (Zaki, 2016). In Saudi Arabia, research was carried out in a public psychiatric health facility in Dammam. The facility has wards with a capacity of up to 500 beds and about 1000 nurses (Alotni & Elgazzar, 2020). The study reported higher levels of burnout mainly among older, married nurses as opposed to single, younger nurses. There is, however, an apparent need to conduct further research on burnout syndrome in Saudi Arabia. This study, therefore, will aim at establishing the prevalence of burnout syndrome among nurses working in Qassim psychiatric hospital. The study will add details missing in previous research and add more data to facilitate solving the existing burnout problems and ultimately improve healthcare service quality in Saudi Arabia.

Conceptual Framework

Burnout depends on psychiatric nurses’ knowledge and their perspective towards work. Demographic details such as, place of work, marital status, sex, age, work experience, qualification, and level of education determines nurses’ vulnerability to burnout syndrome (Gheshlagh et al., 2017). Characteristics of work, including, work resources and demands also contribute to the probability of burnout in psychiatric nurses. This concept and variables are represented in the diagram depicted below.

Methodology

Aim of the Study

The study will aim at determining the prevalence of burnout syndrome among nurses working in Qassim psychiatric hospital.

Objectives of the Study

The objectives of the study include,

1. To establish the causative demographic factors of burnout
2. To establish the risk factors of burnout
3. To advice policy making on the best ways to avoid burnout in nurses
4. To determine the level of burnout syndrome in nurses in Qassim psychiatric hospital

Philosophical Stance

The study will be evaluating the level of burnout in psychiatric nurses in Qassim city. Demographic data and work-related factors significantly affect the prevalence of burnout syndrome. A cross-sectional research is suitable since it gives the participants a platform to describe how they feel concerning burnout.

Research Design

Once approved, this research will apply the use of a cross-sectional study design. This research design has great descriptive capabilities that enable it to effectively assess the feelings of nurses involved in the study. This design is suitable for the projected sample size and promises the most viable data. This study uses questionnaires to collect data, a cross-sectional research design will be effective in systematically obtaining information

Study Population

The study will target registered nurses with a minimum of one year of working in Qassim psychiatry hospital.

Exclusion Criteria

Nurses who have less than a year of experience or those that decline to participate will be excluded from the study.

Sample

The study targets an estimation of about 200 registered nurses. This is a good percentage of the total number of nurses working in the facility. This sample size can therefore represent the entire target population.

Sampling Technique

The research will use the simple random sampling technique to select participants. This method is orderly, effective, and eradicates bias, thus ensuring a representative sample of the target population. This technique was also used on other reviewed articles and provided viable results.

Research Instruments

The study will employ questionnaires and to obtain data from the participants. Relevant hospital records will also be consulted for information about the conduct of the nurses (this may include absenteeism, records of any conflicts, and history of nurses’ resignations). The Maslach Burnout Inventory (MBI) is also used and is validated by detailed studies for more than thirty five years. This tool will be translated to Arabic for easy comprehension of by the participants.

Ethical Issues

Through the ministry of health, the government will approve the research and the proposed methodology before commencing. The rules and regulations of the Arabian government will also be considered. The research procedure will be presented for approval to the hospital’s ethical review committee and the university board of directors, as well as the instructor. A printed and signed informed consent will also be a mandatory requirement for all the participants. Personal information obtained will be handled with privacy and confidentiality. This data will only be used for the analysis of the research findings.

Procedure

After approval and selection of the participants, the research questionnaires will be distributed among the nurses. The questionnaires will be filled and returned to the researcher. The questionnaires will consist of two sections, Maslach Burnout Inventory (MBI) to measure burnout, and, the participants’ demographic data. Demographic entries will include the occupation, nationality, gender, marital status, working hours and schedule, level of education, alcohol consumption and smoking status, and age. The second part will contain the Maslach burnout inventory (MBI) entries. It is a 22-component, self-reported tool designed to conduct a quantitative evaluation of various categories of BOS. All entities are graded on a five-point mark, 0 = never/no change, 1 = rarely, 2 = some times, 3 = often, and 4 = always/large change. The total of the entry answers are respectively grouped into: 27–37 = no burnout, 38–49 = mild burnout, 50–69 = moderate burnout, 70–89 = severe burnout, and >1 = very severe burnout. The Cronbach’s alpha for the Maslach burnout inventory is 0.80 with a variation of 0.79–0.81 for the subscales

Data Analysis

The obtained data will be synthesized using the statistical package for the social sciences (SPSS) software, version 24. (IBM Software, Chicago, USA). Descriptive statistics for the occupation, education level, marital status, gender, and age of the subjects were analyzed. The standard deviation and mean values for the MBI were evaluated for all the subjects. The relationships between sociodemographic and BOS variables were assessed by multi-nominal logistic regression analysis. Statistical significance was indicated by P < 0.05.

Work Plan

The study will be conducted and be ready for presentation over five months.

References

Alharbi, S. (2019). Occupational stress, coping strategies, and quality of life among nurses in general and psychiatric setting in Jeddah City—KSA. Open Journal of Psychiatry, 9(2), 124-137.

Alotni, M. A., & Elgazzar, S. E. (2020). Investigation of burnout, its associated factors, and its effect on the quality of life of critical care nurses working in Buraydah Central Hospital at Qassim Region, Saudi Arabia. The Open Nursing Journal, 14(1), 190-202.

Dawood, E., Mitsu, R., & Monica, A. (2017). Perceived psychiatric nurses job stress: A cross sectional study. IOSR Journal of Nursing and Health Science, 6(2), 37-47.

Gheshlagh, R., Parizad, N., Dalvand, S., Zarei, M., Farajzadeh, M., Karami, M., & Sayehmiri, K. (2017). The prevalence of job stress among nurses in Iran: A meta-analysis study. Nursing and Midwifery Studies, 6(4), 143-148.

Noureen, A., Shah, A. A., & Shah, M. A. (2019). The moderating role of coping strategies in occupational stress and burnout among mental health practitioners in Pakistan. Clinical and Counseling Psychology Review, 1(1), 28-43.

Zaki, R. (2016). Job stress and self-efficacy among psychiatric nursing working in mental health hospitals at Cairo, Egypt. Journal of Education and Practice, 7(20), 103-113.

Appendix

Questionnaire

Section 1

Please respond to each of the following questions accordingly.

1. Age
2. Gender
3. Occupation
4. Marital status
5. Nationality
6. Working hours
7. Shift
8. level of education
9. Do you take alcohol or smoke? If yes, specify and estimate the duration and onset.

Section 2. Maslach Burnout Inventory (MBI)

On a scale of 1 – 5, estimate the level of burnout you experience. Mark as appropriate in the options below with 1 being the lowest and 5 being the highest.

1. I feel emotionally exhausted from my work.
2. I feel overworked at the end of my shift.
3. I feel exhausted when I get up in the morning and have to tackle another day work.
4. I can easily understand how my patients feel about things.
5. I feel like my work has a positive impact on my patients.
6. I feel I treat some patients as if they were impersonal objects.
7. Working with patients and colleagues all day is really a strain for me.
8. I deal very effectively with the problems of my patients.
9. I feel burned out from my work.
10. I feel I’m positively influencing other people’s lives through my work.
11. I’ve become more callous toward people since I took this job.
12. I worry that this work is hardening me emotionally.
13. I feel very strong.
14. I feel frustrated by my career.
15. I do not like my work.
16. I feel I’m worked in my work.
17. I don’t really care what happens to some patients.
18. I feel exhilarated after working closely with my patients.
19. I have accomplished many worthwhile things in this job.
20. I feel like I’m giving up.
21. I deal with emotional problems very calmly in my work
22. I feel patients blame me for some of their problems.