Docx (7).docx

Running head: BURNOUT

1

Nursing Burnout: Concept Analysis Amie Seitz Chamberlain College of Nursing NR 501: Theoretic Basis for Advanced Nursing Practice October 2017

BURNOUT

2 Nursing Burnout: Concept Analysis

Nurses carry a heavy burden of caring for others causing burnout quickly. Healthcare has one of the highest instances of burnout and nurses are at the forefront of this (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). In the field of nursing, a concept analysis provides a way to test nursing theory and develop new theories based on concepts and phenomenon that are seen in practice. Burnout is one of the unexplained phenomena. With such a high prevalence of nurses becoming emotionally exhausted in their jobs causing high job turnover it is important to explore a concept analysis on nursing burnout. For the purpose of this paper, the concept of burnout will be reviewed using Orem’s theory of self-care. This paper will define and explain the nursing concept of burnout, provide a literature review, review antecedents and consequences, empirical referents, construct cases, theoretical application and conclusion. Definition and Explanation of nursing concept Burnout is defined as exhaustion or cessation of operation (Burnout, n.d.). This concept is thought to be more prevalent in healthcare professionals because of the type of high-stress jobs performed and the environment they work in (Manzano-García, & Ayala, 2017). In healthcare, nurses take on the responsibility of caring for sick and dying patients and at many times invest much of their physical and emotional strength into the care that is given, thus leading to burnout. Nursing burnout has been known as many other terms such as burnout syndrome, chronic stress, and compassion fatigue all of which are a result of a personal phenomenon where a nurse is no longer able to operate the duties given (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). Burnout can affect anyone not just nurses, but any worker in a high-stress environment (Salvagioni et al., 2017). Burnout is an effect of the lack of personal accomplishments and job

BURNOUT

3

dissatisfaction that causes a decrease in productivity and decreased overall health in nursing (Conceição das Merces et al., 2017). This is a problem that needs to be addressed. Literature Review Much of the literature reviewed revealed that nursing burnout has become a problem that is preventable. While burnout is an individual phenomenon, there are outreaching effects on the work environment and patient outcomes (Jaracz et al., 2017). All of the literature reviewed confirmed that emotional exhaustion, depersonalization, work environment, perceived failures and job satisfaction are directly related to burnout (Conceição das Merces et al., 2017; Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). With nurse working long hours and giving so much time and energy to the patient the literature supports that burnout is possible. With burnout being a result of chronic stress at work, the literature also supports that this stress has consequences to health promotion in the nurse and progression of disease (Savagioni et al., 2017). The prevalence of burnout in one study was linked to levels of nursing autonomy in the workplace, micromanagement, staffing, and the workload a nurse has (Khamisa, Peltzer & Oldenburg, 2013). Job-related stress was also found in the literature to influence the perception of self and personal temperament (Jaracz et al., 2017). It is also important to note that high levels of stress and underachievement of personal goals influence consequences such as lateral violence, medical errors and unsafe patient outcomes (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). While the literature stated that burnout can happen to anyone in high-stress environments emergency room nurses and ICU nurse specialties were some of the highest likelihood to present with burnout due to stress and job demands (Gómez-Urquiza, De la Fuente-Solana & AlbendínGarcía, 2017). Evidence from literature stated that working conditions and a person’s

BURNOUT

4

socioeconomic status pose a risk for nursing burnout (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). The literature used different types of empirical referent like different types of questionnaires were used to measure job-related stress. One literate found through these questionnaires hat nurses have a higher rate of anxious temperament and experienced greater intensity of job-related stress (Jaracz et al., 2017). A cross-sectional study of nurses in Bahia Southwest concluded, using the Maslach burnout inventory and Human Services Survey, that the prevalence of Burnout was 58.3% in nurses (Conceição das Merces,2017). Using Maslach Burnout Inventory one study delved in further to find that Emotional Exhaustion is 36% of burnout, Depersonalization is 36% of burnout, and low Personal Accomplishment 29 % of burnout (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). Manzano-García & Ayala used the e-Delphi web-based questionnaire, to show the factors that working nurses felt influence burnout were relationships between work related stress, burnout, job satisfaction and general health (2017). Manzano-García & Ayala found that little research has been done on burnout, however, there is inconsistency in the antecedent that leads to burnout (2017). Burnout was found to be a leading cause of disease progression and poor health in nurses (Khamisa, Peltzer & Oldenburg, 2013; Savagioni et al., 2017). Some specific diseases are hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, insomnia, depression, irritability, mental illness, severe injuries and mortality below the age of 45 years (Gómez-Urquiza, De la FuenteSolana & Albendín-García, 2017; Savagioni et al., 2017). Manzano-García & Ayala suggested that more research needs to be done in recognizing tasks that nurses perform that lead to nursing

BURNOUT

5

burnout (2017). Also, it was shown that the lack of organizational support contributes to the prevalence of burnout and increases the feelings of failure by nurses (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). The need for early intervention and education can improve personal and work-related impacts of burnout (Conceição das Merces et al., 2017; Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017; Jaracz et al., 2017; Savagioni et al., 2017). Defining Attribute A defining attribute is used to show when the concept may be present. Through the literature review, the common attributes leading to burnout include a high-stress environment, working long hours, and disease progression. High levels of burnout are a direct result of workplace stress and are related to role conflict in nursing (Khamisa, Peltzer & Oldenburg, 2013). Role conflict as described by Khamisa, Peltzer & Oldenburgs study is when nurses feel that their job doesn’t matter to the employer and they are unclear how to perform their duties any longer (2017). The hours worked by nurses’ effect physical health and mental problems, leading to burnout if untreated (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). Antecedent and Consequence Antecedents are presented to give evidence of what leads to a concept. Two antecedents that seem to go hand in hand with burnout would be physical and mental fatigue. These antecedents keep nurses from being able to focus on their own self-care. A person’s reaction to physical and mental fatigue is stress, which can lead to burnout in their profession (Jaracz et al., 2017). A consequence of burnout is decreased quality of care and poor patient outcomes from the nurse to the patient. Poor patient outcomes are a consequence from nursing errors and even

BURNOUT

6

lateral violence and incivility to patients when a nurse is over stresses and has burnout in the professions (Filgueira Martins Rodrigues, Pereira Santos & Sousa, 2017). Empirical Referents Empirical referents will quantify the existence of burnout in the field demonstrating the occurrence of the concept. One Empirical referent, an indicator of occurrence, is the use the emotional exhaustion and depersonalization subscale (Gómez-Urquiza, De la Fuente-Solana & Albendín-García, 2017). The use of this subscale assesses various aspects of burnout, specifically emotional exhaustion, depersonalization, and personal accomplishment (GómezUrquiza, De la Fuente-Solana & Albendín-García, 2017). A second empirical referent is the use of burnout questionnaires. The uses of questionnaires, like the e-Delphi questionnaire, gathers data about nurse’s opinions of what was influencing nursing burnout (Manzano-García & Ayala, 2017). The use of the empirical referents will give data that can be interpreted into application. Construct Cases Construct cases are formed to show how the defining attributes are illustrated in either real life or fictitious examples. Model Case Nurse Theresa works in the hospital in the ICU. Theresa has been married for 5 years, has four kids and is in school for her master’s degree. Theresa picks up 2-3 extra shifts every week for extra money. Every shift she stays after work for more than an hour. She has also volunteered to be on the education committee in the hospital. Theresa never takes time off for herself and has built up 200 days of paid time off. Recently she had surgery for stomach ulcers related to stress and came back to work the first available day she could. Theresa has become irritable at work and there have been many complaints from patients that wrong meds were given to them and that

BURNOUT

7

Theresa has been rude. Theresa also coaches her daughter soccer team and is the team parent for her son’s baseball club. This model case illustrates all the attributes of burnout. Theresa works in the ICU which is a high-stress environment, she stays late and puts family and patients’ needs above her own. This nurse gave all she could to her job, her family and her schooling. She also has been having health problems and not taking time to deal with them. Borderline Case Some attributes are provided in borderline cases. Nurse Gretchen works in a demanding emergency room. Gretchen is married but has only dogs at home and is in school for her master’s degree. Gretchen works registry nurse positions at least 1 day a week for extra money. Gretchen never takes time off for herself and has built up 80 days of paid time off. Gretchen has become irritable at work and there have been many complaints from patients that she has been rude and forgetful. Gretchen spends what time she can with her husband and dogs, but wishes she could spend more. Gretchen is showing some attributes of burnout, she works long hours and extra hours due to financial constraints. Gretchen has a high-stress job and takes little time off. Contrary Case Nurse Amie works three 12-hour shifts a week. She treats her patients equally and finishes all her charting and work on time. Amie regularly sees the doctor for her physicals and is happy with how her health is. Amie teaches in church and coaches her daughter’s soccer team. This case is an illustration of what the concept is not. This nurse is comfortable in both work and home and has found a happy medium.

BURNOUT

8

A contrary case will show none of the defining attributes of the concept. Amie is happy in both her work life and at home. She shows no signs or attributes contributed to burnout. Theoretical Application of Concept Concepts are building blocks used to increase knowledge and understanding of nursing theory. The use of Orem’s self-care deficit theory validates the concept of burnout in nursing. According to this theory when an agent has a deficit it must be corrected in order to care for others (Mills, Wand & Fraser, 2015). Providing a theory along with a concept helps to analyze, give meaning and remove any limitations placed on a theory. For a nurse to provide compassionate care, they must have the mental and physical capability to do so. The capacity to care is questionable if the nurse neglects to care for their own physical and psychological needs (Mills, Wand & Fraser, 2015). Orem’s theory suggests that it is essential for mind and body to be in harmony (Mills, Wand & Fraser, 2015). When the attributes of burnout become evident, implementing self-care theory can put into check the nurse’s overall health and focus health on the self-care needs. This would require self-reflection either through journaling or through the use of any of the empirical referents. Conclusion Concepts give a foundation for the knowledge and understanding of nursing theory. Burnout is a concept in nursing that comes as a result of many things: heavy workloads, physical fatigue, mental fatigue, and long hours. The progression of the disease states can increase as stress and poor working conditions are placed on the nurse. Understanding the relation of concepts seen every day in advanced nursing practice, like Family Nurse Practitioner, can help in the integration of nursing theory. By using theories such as Orem’s self-care, a Nurse

BURNOUT

9

Practitioner can provide for better outcomes. Nurses focusing on self-care need treat their body and mind first then they can, in turn, provide better patient care and outcomes. The information gained here from this concept analysis is important to future practice. The use of evidence-based research and the use of theoretically based concept analysis can provide direction and education on emerging phenomenon. Moving into future practice, concept analysis provides reasoning for a phenomenon that seems unrelated and provides knowledge that gives better nursing judgment. Also, understanding the significance of concepts provides for the new development of theories that validate the field of practice.

BURNOUT

10 References

Burnout. (n.d.). Retrieved November 10, 2017, from https://www.merriamwebster.com/dictionary/burnout Conceição das Merces, M., Almeida Lopes, R., de Souza Silva, D., Sousa Oliveira, D., Lua, I., Santana Mattos, A. I., & D'Oliveira Júnior, A. (2017). Prevalence of Burnout Syndrome in nursing professionals of basic health care. Revista De Pesquisa: Cuidado E Fundamental, 9(1), 208-214. doi:10.9789/2175-5361.2017.v9i1.208-214 Filgueira Martins Rodrigues, C. C., Pereira Santos, V. E., & Sousa, P. (2017). Patient safety and nursing: interface with stress and Burnout Syndrome. Revista Brasileira De Enfermagem, 70(5), 1083-1088. doi:10.1590/0034-7167-2016-0194 Gómez-Urquiza, J. L., De la Fuente-Solana, E. I., & Albendín-García, L. (2017). Prevalence of Burnout Syndrome in Emergency Nurses: A Meta-Analysis. Critical Care Nurse, 37(5), e1-e9. doi:10.4037/ccn2017508 Jaracz, M., Rosiak, I., Bertrand-Bucińska, A., Jaskulski, M., Nieżurawska, J., & Borkowska, A. (2017). Affective temperament, job stress and professional burnout in nurses and civil servants. Plos ONE, 12(6), 1-11. doi:10.1371/journal.pone.0176698 Khamisa, N, Peltzer, K. Oldenburg, B. (2013). Burnout in Relation to Specific Contributing Factors and Health Outcomes among Nurses: A Systematic Review. International Journal of Environmental Research and Public Health. doi:10.3390/ijerph10062214 Manzano-García, G., & Ayala, J. (2017). Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study. Plos One, 12(4), e0175352. doi:10.1371/journal.pone.0175352

BURNOUT

11

Mills, J., Wand, T., & Fraser, J. A. (2015). On self-compassion and self-care in nursing: Selfish or essential for compassionate care?. International Journal Of Nursing Studies, 52(4), 791-793. doi:10.1016/j.nedt.2013.07.011. Salvagioni, D. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. d. (2017). Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. Plos ONE, 12(10), 1-29. doi:10.1371/journal.pone.0185781