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BURNOUT AMONG NURSES OF MATERNITY DEPARTMENT: A RESEARCH PROTOCOL

BURNOUT AMONG NURSES OF MATERNITY DEPARTMENT: A RESEARCH PROTOCOL

1. Marami BaishyaM. Sc. Nursing (Obstetrics & Gynaecology) Trainee, Regional College of Nursing, Guwahati – 781 032, Assam,

2. Anupama DuttaAssociate Professor of Obstetrics & Gynaecology, Regional College of Nursing, Guwahati – 781 032, Assam, India

3. Meenakshi MahantaAssistant Professor of Psychology, Regional College of Nursing, Guwahati – 781 032, Assam, India

 

Abstract:

Objectives1. To examine the level of burnout reported by nurses of maternity department.2. To find out the relationship between burnout and demographic variables like age, religion, marital status, years married, general and professional education, children and number of children.3. To explore factors that may influence the level of burnout among nurses working in maternity department.

MethodsHundred nurses working in the maternity department of Gauhati Medical College Hospital, Guwahati will be selected by non probability purposive sampling. Demographic proforma, factors influencing level of burnout, and Assamese translation of Maslach Burnout Inventory are the tools to be used.

ResultsData analysis will be planned on the basis of objectives of the study using statistical methods of descriptive and inferential statistics.

Conclusions The implications of the present study finding and future directions would be stated.

Keywords: Sampling. Demography. Dependent variable. Pilot study. Depersonalisation.

Introduction

Freudenberger1 used the term burnout for the first time. Feelings associated with failure and exhaustion was described. It is a state of exhaustion at the levels of physical, mental, and emotional levels. It results from high expectation and persistent stress in combination. The consequence is depletion of one’s resources; thus, having a negative impact on work and other areas of life. The organisation is also adversely effected. Continued dissatisfaction is reflected; which can ultimately progress from boredom to depression. Irritation, exhaustion, and ailment follows. Experience of pressure together with lack of satisfaction causes exhaustion and then burnout.

Burnout in medical professionals is drawing attention these days and has become a serious issue. Healthcare professionals are vulnerable to burnout because of their nature of work. Stress at workplace is related to job satisfaction and burnout. They can lead to poor health among nurses.[2] Nurses report higher levels of burnout compared to physicians or other healthcare workers.[3-5]

Proposed factors for nursing stress include: work overload, interprofessional conflict, lack of clarity, task ambiguity, and supervision problems. The amount of time spend with patients, the intensity of patients' emotional demands, as well as patients' poor prognosis are also related to burnout in nurses. Age is a sociodemographic factor related to burnout.[5]

Motivated workforce is key to well-functioning system. A key indicator is emergency obstetric care for health system performance. It is also a woman's fundamental right. For safe motherhood, strengthening human resources capacity and also improving the environment are top priorities. A crucial element is health worker performance for successful functioning of health system. It also impacts the quality of care. In low-income countries, for both recruitment and retention, performance boosting is a crucial step. And performance depends upon motivation, skills, intellect and resources.[6]

Burnout affects quality and quantity of healthcare workers' services and care. As a result, there are poor patient outcomes as well as health infrastructure. In addition, the challenge of reducing maternal mortality rate is exacerbated. For health in general and maternal health in particular, wellbeing of healthcare workers is of paramount importance. This facilitates providing effective antenatal, intrapartum and emergency obstetric care, as well as postnatal services and care. These are threatened by burnout.[2]

Need for the study

It is mostly in Europe and United States that the burnout studies on nurses are conducted. Studies from Asian countries are few. In view of the paucity of Indian studies in this area, the present work was undertaken to identify the predictors of burnout in an Indian nursing population. As the socio-cultural background of Indian nurses varies widely from their western counterparts, we expected to identify predictors of burnout relevant to them. Finding predictors of burnout relevant in an Indian setting should have important policy implications in human resource management in this sector in similar developing countries.[7]

Although burnout in large organisations has been examined in many studies, in general there has been a lack of concentration on nurses and on hospital settings, especially in India. In addition, there are relatively few studies investigating burnout among Indian nurses. In many low-income countries, health service delivery is crippled by a health workforce crisis. High salaries and living conditions of high-income countries attract doctors and nurses of poorer countries. Thus, many developing countries are depleted of human capital due to this migration of skilled labour. In India, the human resource crisis is acute.[8]

Moreover, with the increasing complexities and the changing patterns of society, the stress in the environment leading to burnout is increasing day by day. Study of burnout and factors influencing it will therefore enable us to find out suitable ways to reduce stress among nurses and thereby improving the quality of nursing care. Thus the need for the study is felt.

Statement of the problem

A study to assess burnout among nurses of maternity department in Gauhati Medical College Hospital, Assam.

Objectives of the study

1. To examine the level of burnout reported by nurses of maternity department.

2. To find out the relationship between burnout and demographic variables like age, religion, marital status, years married, general and professional education, children and number of children.

3. To explore factors that may influence the level of burnout among nurses working in maternity department.

Hypotheses

H1: There are significant association between burnout and socio-demographic variables.

H2: There are significant association between selected factors and burnout.

Material and Methods

Setting of the study

Gauhati Medical College Hospital (GMCH), Assam is selected as the setting of the study.

Population

Nurses who are working in the maternity department of GMCH and Annex GMCH.

Sample

For the purpose of present study, 100 numbers of nurses will be selected.

Sampling technique

The investigator will utilise non probability purposive sampling.

The criteria for selection of the sample are-

1. Nursing personnel who will be available during the data collection period

2. Nursing personnel who are willing to participate in the study

3. Nurses who are female

Variables

In the present study, demographic variables are the age, religion, marital status, years married, general and professional education, children and number of children. Dependent variable is burnout.

Fig 1: Schematic representation of research design

Description of tools

Demographic proforma: It is prepared to gather the background information regarding the participations under study. It consists of seven items. Variables are socio-demographic data, e.g. age, religion, marital status, years married, education, children, and number of children.

Factors influencing level of burnout: It consists of 13 items. These are travelling time to work, primary workplace, working hours per week, nurse/nurse conflict, nurse/doctor conflict, availability of doctors to work with, lack or inadequate nursing personnel, poor wages, too frequent night duties, inadequate security during night duties, job status, years in current job, and additional work.

It was evident from the literature review that because of the very nature of the type of data required to be analysed to assess level of burnout and factors that may influence the level of burnout among health care workers, standardised tools are essential. After an extensive literature search, authors found that Maslach Burnout Inventory (MBI) is the golden scale for assessing burnout among nurses.

Burnout self-test (MBI) is subdivided into three categories:

• Section A – Emotional exhaustion

• Section B – Depersonalisation

• Section C – Personal achievement

MBI contains 22 items which are answered as never, a few times per year, once a month, a few times per month, once a week, a few times per week and every day.

Section A – Emotional exhaustion contains seven items

Section B – Depersonalisation contains seven items

Section C – Personal achievement contains eight items

Scoring

Section A: Emotional exhaustion

Emotional exhaustion: Testifies to fatigue at the very idea of work, chronic fatigue, trouble sleeping, physical problems. For the MBI, as well as for most authors, “exhaustion would be the key component of the syndrome.” Unlike depression, the problems disappear outside work.

• Total 17 or less: Low-level burnout

• Total between 18 and 29 inclusive: Moderate burnout

• Total over 30: High-level burnout

Section B: Depersonalisation

Depersonalisation (or loss of empathy): Rather a dehumanisation in interpersonal relations. The notion of detachment is excessive, leading to cynicism with negative attitudes with regard to patients or colleagues, feeling of guilt, avoidance of social contacts and withdrawing into oneself. The professional blocks the empathy he can show to his patients and/or colleagues.

• Total 5 or less: Low-level burnout

• Total between 6 and 11 inclusive: Moderate burnout

• Total of 12 and greater: High-level burnout

Section C: Personal achievement

The reduction of personal achievement: The individual assesses himself negatively, feels he is unable to move the situation forward. This component represents the demotivating effects of a difficult, repetitive situation leading to failure despite efforts. The person begins to doubt his genuine abilities to accomplish things. This aspect is a consequence of the first two.

• Total 33 or less: High-level burnout

• Total between 34 and 39 inclusive: Moderate burnout

• Total greater than 40: Low-level burnout

A high score in the first two sections and a low score in the last section may indicate burnout.

Translation of the scale

The inventory was translated from English into local language Assamese by an expert not related to this study. It was later back-translated into English by another independent expert, not acquainted with the original version. The back-translation was subsequently compared with the original version by a psychiatrist for conceptual equivalence of the items. Necessary finer adjustments were made to convey the correct information to the participants.

Reliability of the scale

The reliability of the scale was established by data collected from ten staff nurses, who are working in the maternity department of Gauhati Medical College Hospital. The reliability has been drawn by using Split-Half Spearman Brown Formula. The formula is as follows:

rSB = 2r/(1+r)

where r is the Pearson Product moment correlation co-efficient.

Reliability of Emotional exhaustion

The calculated value of r = 0.79

Hence, rSB = 0.88

Since the calculated value of rSB (reliability) is 0.88, which is highly reliable, the tool can be used for main study.

Reliability of Depersonalisation

The calculated value of r = 0.65

Hence, rSB = 0.79

Since the calculated value of rSB (reliability) is 0.79, which is highly reliable, the tool can be used for main study.

Reliability of Personal achievement

The calculated value of r = 0.76

Hence, rSB = 0.86

Since the calculated value of rSB (reliability) is 0.86, which is highly reliable, the tool can be used for main study.

Ethical clearance

Formal written administrative permission is obtained from the Medical Superintendent, Nursing Superintendent and the Head of the Department of the Obstetrics and Gynaecology Department of GMCH.

Informed consent will be obtained from participants.

Data collection procedure

Collection of data is the first step in the statistical treatment of a problem. Assembling facts is thus a very important step and no pains should be spared to see that the data collected are accurate, reliable and thorough.

Data collected for the present study will be through structured questionnaires. The data on demography, factors influencing the level of burnout, and the level of burnout will be collected using this method. Participants will be informed of the purpose of the study and those interested will be given questionnaires that included the measure employed in this study. The test will be administered among nurses working in maternity wards of GMCH. The investigator will give self-introduction and explain the purpose of the study to obtain free and frank responses. The participants will be assured confidentiality of their responses. It will take a minimum of ten to 15 minutes for the participants to respond to the questionnaire and investigator will be personally present each time the test will be administered.

Questionnaires method of data collection is quite popular, particularly in case of big enquires. In this method, a questionnaire is given and the respondent is requested to answer the questions. A questionnaire consists of a number of questions printed or typed in a definite order on a form or set of forms. The merits of this method are there is low cost even when the universe is large and is widely spread geographically, easy to administer, respondents have adequate time, respondent who are not easily approachable, can also be reached conveniently.

Pilot study

A pilot study, aimed at determining the adequacy of study methods and procedures, finding out the feasibility of conducting the study, assessing the appropriateness and quality of instruments, and deciding the plan of statistical analysis, will be conducted. After obtaining the formal administrative permission from the concerned authorities, the pilot study of the present project will be conducted in GMCH. The pilot study will be carried out on 10 samples of nurses working in maternity wards.

Results and Observations

Data analysis will be planned on the basis of objectives of the study using statistical methods of descriptive and inferential statistics. The raw data will be transformed on a master data. The analysis is planned by:

• Data obtained will be analysed using descriptive statistics such as mean, standard deviation and frequency distribution.

• Non-parametric test such as chi-square test will be carried out to determine the variables on which the groups differed significantly as well as to examine the associations between the variables.

Burnout (emotional exhaustion, depersonalisation, and personal achievement)

Table 1: Burnout (emotional exhaustion, depersonalisation, and personal achievement)

N=100

Serial no.

Burnout

Mean

Median

SD

SE

1

Burnout (or emotional exhaustion)

 

 

 

 

2

Depersonalisation or loss of empathy

 

 

 

 

3

The reduction of personal achievement

 

 

 

 

SD=standard deviation, SE=standard error

Discussion

The results of the present study would be discussed in reference to the earlier studies.

Conclusions

The implications of the present study finding and future directions would be stated in the backdrop of the limitations.

References

1. Freudenberger HJ. Staff burnout. J Soc Issues. 1974;30:159-67.

2. Khamisa N, Peltzer K, Oldenburg B. Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review. Int J Environ Res Public Health. 2013;10:2214-40.

3. Thorsen VC, Teten Tharp AL, Meguid T. Health rates of burnout among maternal health staff at a referral hospital in Malawi: a cross-sectional study. BMC Nursing. 2011;10:9.

4. Vanyperen NW, Buunk BP, Schaufeli WB. Communal orientation and the burnout syndrome among nurses. J Appl Soc Psychol. 1992;22:173-89.

5. Vegchel N, Jonge J, Söderfeldt M, Dormann C, Schaufeli W. Quantitative versus emotional demands among Swedish human service employees: moderating effects of job control and social support. Int J Stress Manag. 2004;11:21-40.

6. Bradley S, McAuliffe E. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health. 2009;7:14.

7. Chakraborty R, Chatterjee A, Choudhurys S. Internal predictors of burnout in psychiatric nurses: an Indian study. Ind Psychiatry J. 2012;21:119-24.

8. McAuliffe E, Bowie C, Manafa O, Maseko F, MacLachlan M, Hevey D, et al. Measuring and managing the work environment of the mid-level provider - the neglected human resource. Hum Resour Health. 2009;7:13.