Introduction
Burnout among nurses and other healthcare workers is a matter of increased concern around the globe (De Hert, 2020; Membrive-Jiménez et al., 2020; Pappa et al., 2021; Rezaei et al., 2018). Up to 31% of nurses experienced the symptoms of burnout before the pandemic due to a wide variety of reasons (Monsalve-Reyes et al., 2018). The pandemic had a significant impact on emotional health of healthcare workers, as the cases of depression, anxiety and traumatic stress grew to unprecedented levels (Greenberg, 2020). The levels of burnout also increased to as high as 65% in nurses, which demonstrates a significant rise of burnout prevalence among healthcare workers (Pappa et al., 2021). Burnout in healthcare workers may lead to fatigue, insomnia, sadness, anger, and irritability (Dall’Ora et al., 2020). Moreover, burnout can lead to health problems, such as substance misuse, heart disease, and even diabetes (Yang and Hayes, 2020). Understanding factors that affect development of burnout in nurses is crucial, as it can help to develop effective prevention strategies (Membrive-Jiménez et al., 2020). While factors affecting the development of burnout in nurses is a matter of increased interest among researchers, the matter has not been explored in Malta. Therefore, the proposed research intents to determine factors that contribute to burnout in nurses in Malta.
Research Question
A good research question is essential to guide your research paper, discussion, project, or thesis (Pope, Bruce, and Stanistreet, 2018). The research questions pinpoint the purpose of a study in a clear and concise matter (Indrayan, 2019). There are several crucial characteristics of the research questions that should be followed, including having a clear focus, reachability, feasibility, and relevancy (Pope, Bruce, and Stanistreet, 2018). Moreover, a research question needs to be specific and complex enough to be worth dedicating a full-length research to answering it. This research focuses on determining the factors that contribute to burnout in nurses in Malta. Therefore, this study aims at answering the following research question:
RQ1: What are the factors that contribute to burnout in Nurses in Malta?
Aims and Objectives
The importance of understanding the factors that contribute to development of burnout among nurses is difficult to overstate, as the condition may lead to significant mental and physical health problems as well as decreased productivity of labour (Dall’Ora et al., 2020; Yang and Hayes, 2020). While there is a large body of research focus on determining the factors contributing to burnout in healthcare workers, no research focused specifically on the nurses in Malta. Therefore, the objective of this research reads as follows:
- To determine factors that contribute to burnout symptoms in nurses in Malta.
In order to reach the objective, a series of aims were identified, which are provided below:
- Conduct an in-depth literature review to identify potential contributors to burnout symptoms in nurses in Malta;
- Develop hypotheses that should be tested in the course of the research;
- Establish a quantitative model that can be used to test the hypotheses and answer the research questions;
- Use reliable instruments to and relevant methods to collect quantitative data from a sufficient sample of participants;
- Conduct the quantitative analysis and interpret the results against the results of previous studies and relevant theories.
The proposed study utilises quantitative positivistic approach to the answering the research question. There are three general types of approaches to research, including qualitative, quantitative, and mixed-method approach (Indrayan, 2019). These approaches correspond to three types of research philosophies, which are positivism, constructivism, and pragmatism (Kuhn, 1970). Quantitative research design requires clearly formulated hypotheses tested using statistical analysis, while qualitative research focuses on concepts, thoughts, and experiences of participants to acquire in-depth knowledge (Creswell, 2007). The central benefit of quantitative research is that it can help to answer very specific research questions with high reliability using data collected from a large sample (Creswell, 1994). However, quantitative approach lacks the instruments to explain the results, which can be mitigated with qualitative methods (Creswell, 2007). As a result, researcher often choose to utilise a mixed-method approach to compliment the drawbacks of using only qualitative or quantitative research (Lees and Locke, 2021).
Since this study does not need to explain the results but only determine the factors that contribute to burnout, quantitative approach is the most appropriate method for the study. Quantitative studies presuppose the positivistic viewpoint, which assumes that there is only one reality that can be known and measured (Kuhn, 1970).
Method
The proposed research has a correlational design, which implies that it uses cross-sectional non-experimental design (Pope, Bruce, and Stanistreet, 2018). Correlational studies measure the inter-relationships between two or more variables to answer research questions (Thorogood and Green, 2018). The purpose of the proposed research can be phrased as determining how several factors affect the severity of burnout symptoms. In other words, this study measures the inter-relationships between possible predictors, such as age, gender, marital status, having children, and occupational factors, and the dependent variable, which is the severity of burnout symptoms (Membrive-Jiménezet al., 2020). Therefore, correlational research design is the most appropriate to achieve the purpose of the study.
The research is expected to survey a sample from the target population to measure dependent and independent. The target population is nurses in Malta, which includes all types of settings, such as in-patient, out-patient, and emergency departments. The dependent variable will be the severity of burnout symptoms measured using Burnout Assessment Tool (BAT) version 2.0 (Schaufeli, De Witte, & Desart, 2022). The independent variables will be the demographic variables, including age, gender, marital status, having children measured using a self-created questionnaire, and occupational factors (Membrive-Jiménezet al., 2020). The occupational factors include overtime work, inadequate staffing, and high job demand, which will also be measured using self-created questionnaires (Khamisa, 2019).
The required sample size was calculated using the following formula
Where:
- Z = Z-score for the accepted significance level
- P = population proportion
- M = margin of error
Considering that the population size of nurses in Malta is 6,180 (Khamisa, 2019), the confidence level is 95% (Z = 1.96), the margin of error is 7.5% and the population proportion is assumed to be 50%, the sample size can be calculated the following way:
Thus, the required sample size is 167 nurses from all types of settings in Malta.
The participants will be recruited using random sampling. In particular, hospital authorities of random hospitals will be contacted with a request to assist in the research. After the hospital authorities give their formal agreement, nurse managers will be sent recruitment letters with an overview of the purpose of the research and its design. Nurse managers will be asked to distribute the questionnaires among nurses. The recruitment letters will also include an informed consent form and a link to Survey Monkey, which will be used as the platform for automatic data collection. The recruitment process will stop as soon as the required number of valid responses is acquired.
No help from gatekeepers or interpreters/translators will be used. The data will be collected using online questionnaires. No pilot study will be conducted. The proposed research is expected to take up to 6 months. The survey will be conducted anonymously by not collecting names of participants. All participants will be solicited through email that provided details of the research, assurances for privacy, and the optional nature of participation. Participants were instructed that their participation in the research will voluntary, and they may withdraw at any time without fear of repercussions. The research will comply with all the ethical standards, such as avoiding targeting the vulnerable populations or people under 18 and touching upon sensitive topics.
Research Outcomes
The primary expected research outcome is increased understanding of factors that contribute to burnout among nurses in Malta. This will allow nurse managers to reduce the effect occupational factors on at-risk populations to reduce burnout symptoms in nurses in different setting in Malta. As a result, the research will allow to improve emotional and physical health of the target population and improve their work efficiency.
Timeline
The timeline for the research is provided below:
- Proposal writing and defence. 15 September 2022 – 9 October 2022.
- Literature Review. 10 October 2022 – 31 October 2022
- Primary data collection. 1 November 2022 – 20 November 2022
- Data analysis. 20 November 2022 – 30 November 2022.
- Writing the final paper. 1 December 2022 – 24 December 2022.
Reference List
Creswell, J.W. (1994) Research design: Qualitative and quantitative approaches. Thousand Oaks: Sage.
Creswell, J.W. (2007) Qualitative inquiry & research design. Thousand Oaks: Sage Publications.
Dall’Ora, C. et al. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1), pp. 1-17.
De Hert, S. (2020) ‘Burnout in healthcare workers: Prevalence, impact and preventative strategies’, Local and Regional Anesthesia, 13, pp. 171–183.
Farrugia, C. (2020).Malta records sharpest increase in nursing staff [online]. Web.
Greenberg, N. (2020) ‘Mental health of health-care workers in the COVID-19 era’, Nature Reviews Nephrology, 16(8), pp. 425-426.
Indrayan, A. (2019). Research Methods for Medical Graduates. United States: CRC Press.
Khamisa, N. et al. (2019) ‘Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in South Africa’, Health SA Gesondheid, 22, pp. 252– 258.
Kuhn, T. S. (1970) The Structure of Scientific Revolutions (2nd edn). United States: University of Chicago Press.
Membrive-Jiménez, M. J. et al. (2020) ‘Burnout in nursing managers: A systematic review and meta-analysis of related factors, levels and prevalence’, International Journal of Environmental Research and Public Health, 17(11), article 3983.
Monsalve-Reyes, C. S., et al. (2018) ‘Burnout syndrome and its prevalence in primary care nursing: A systematic review and meta-analysis;, BMC Family Practice, 19(1), pp. 1-7.
Lees, A. and Locke, R. (2021). Mixed-Methods Research in Wellbeing and Health. United Kingdom: Taylor & Francis.
Pappa, S., et al. (2021) ‘From recession to depression? Prevalence and correlates of depression, anxiety, traumatic stress and burnout in healthcare workers during the COVID-19 pandemic in Greece: A multi-center, cross-sectional study’, International Journal of Environmental Research and Public Health, 18(5), article 2390.
Pope, D., Bruce, N., and Stanistreet, D. (2018) Quantitative Methods for Health Research: A Practical Interactive Guide to Epidemiology and Statistics. United Kingdom: Wiley.
Rezaei, S. et al. (2018) ‘Prevalence of burnout among nurses in Iran: A systematic review and meta‐analysis’, International Nursing Review, 65(3), pp. 361-369.
Schaufeli, W., De Witte, H., & Desart, S. (2020). Burnout Assessment Tool: Version 2.0. Web.
Thorogood, N. and Green, J. (2018) Qualitative Methods for Health Research. United Kingdom: SAGE Publications.
Yang, Y. and Hayes, J. A. (2020) ‘Causes and consequences of burnout among mental health professionals: A practice-oriented review of recent empirical literature’, Psychotherapy, 57(3), pp. 426-436.