Introduction
It is important to note that the problem of burnout among nursing professionals is a major issue that affects the specialists’ wellbeing, patients’ safety, and organizations’ performance. There are an array of factors, which contribute to the prevalence of burnout in a nursing workplace environment, and there is also a wide range of effects of the problem. Therefore, a thorough understanding of correlational and causational links between nursing burnout and other factors is of paramount importance since all stakeholders are impacted by the issue. The given literature review will focus on nursing burnout to identify the critical predictors and causal elements as well as effective intervention methods, which include self-care and empowerment.
Problem Statement
The identified workplace problem is nursing burnout, which hinders the ability of healthcare professionals, endangers patients’ wellbeing, and decreases organizational performance. The vast majority of the critical factors are linked to nursing practice and nursing administration areas, which require better allocation of the workload, improved management, and additional interventions. The recent statistics suggest that “70% of nurses report feeling exhausted and burned out at some point during their careers,” and “nurse burnout costs hospitals $9 billion a year, and the healthcare industry at-large about $14 billion a year” (Katulka, 2021, para. 1). Examples of negative patient outcomes include “deterioration of teamwork climate, safety, and job satisfaction,” which lead to a decline in patient safety, and “higher levels of burnout were also associated with unfavorable outcomes, patient dissatisfaction, and increased patient and family complaints” (Garcia et al., 2019, p. 562). Therefore, nursing burnout has a negative multifactorial impact on patient outcomes.
Critical Analysis and Synthesis of Literature
Nursing Burnout Predictors and Effects
The purpose of the study is to provide a comprehensive summary of how burnout interacts with other critical workplace variables in nursing because the problem is that nursing burnout is identified as an outcome (Dall’Ora et al., 2020). The theoretical framework utilized is the Maslach Burnout Inventory, which is an evaluative scale of assessment. The latter is necessary to analyze the relationship between burnout and factors, such as “high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards” (Dall’Ora et al., 2020, p. 1). In the case of sample size, “ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout” (Dall’Ora et al., 2020, p. 1). The relevant characteristics include United States databases MEDLINE, CINAHL, and PsycINFO. Data collection was based on a search for work-related factors and burnout in a wide range of healthcare facilities with the exclusion of editorials, commentaries, and literature reviews. No statistical tests were used, but data analysis was conducted on the basis of Maslach’s categorization. The findings indicate that predictors of burnout include “low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job, and psychological demands, low task variety, role conflict,” and also there are elements of “low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity” (Dall’Ora et al., 2020, p. 1).
Psychological Empowerment on Nurses Burnout
The primary purpose of the study is to observe the effects of psychological empowerment on nurses and assess the impact of marital status, experience, gender, and age of burnout perception, and the problem is the burnout itself (Permarupan et al., 2019). The core theoretical framework is based on psychological empowerment, which is also the intervention, as a policy-based method of performance enhancement, and no other theoretical frameworks were used. The sample size was 432 (n=432) because out of 550 survey questionnaires sent, only 432 were completed fully, and no control group or other relevant characteristics were present. The study was conducted among Malaysian nurses in Malaysia. The data collection involved registered hospitals of the Ministry of Health and healthcare facilities listed on the official website, from which registered nurses were contacted and asked to take the survey. Statistical tests used include common method variance, Mardia’s online test for the multivariate normality, PLS-SEM test, Cronbach’s alpha (α), and Composite Reliability. The measurements were statistically significant because p = 0.000 (p < 0.05), where psychological empowerment as an intervention reduced the effects of burnout, and age, gender, marital status, and working experience affected burnout perception in a differential manner (Permarupan et al., 2019).
Nurse Burnout in Hemodialysis Centers
The purpose of the study is to determine the current burnout level and related manifestations of the issues among hemodialysis nursing staff because it is a high-pressure and high-risk work environment (Ling et al., 2020). No interventions are used. The theoretical framework of the Maslach Burnout Inventory is used for the survey approaches, which is the most effective tool to measure burnout. The sample size is 65 (n=65) out of 70 nurses, which means that the response rate is equal to 92.9%, no control group or other relevant characteristics were used. In the case of relevant setting elements, “registered nurses working in hemodialysis centers were randomly selected from 5 comprehensive tertiary level hospitals in Sichuan Province, China” (Ling et al., 2020, p. 1). The data collection was based on an anonymous online questionnaire, which utilized the most popular Chinese chatting platform called WeChat. The statistical data analysis methods included “a non-paired t-test, an analysis of variance (ANOVA), and multiple logistic regressions” on the basis of s SPSS V.17.0 statistical software instrument. The findings indicate that a high burnout level was associated with emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment in a statistically significant manner with p scores equal to p < 0.01, p < 0.01, and p < 0.05, respectively (Ling et al., 2020).
Burnout and Self-Care
The main purpose of the study is to review the information and develop a self-care course to address burnout with a subsequent analysis of the course effectiveness through surveys because burnout is a costly problem for healthcare organizations (Couser et al., 2020). No interventions or theoretical frameworks are used. The total number of participants is equal to 134 (n=134), and no control group or other relevant characteristics can be noted. In the case of the setting factors, “the course design and implementation of an educational program developed and implemented at the Mayo Clinic in Rochester, Minnesota” of the United States (Couser et al., 2020, p. 1). The data collection method is based on a survey, which is part of the course program. No data analysis was performed, and survey data were presented in table or graph formats. The results have no significant outcome, and it is mostly comprised of identified recommendations, which include healthy nutrition and adequate sleep and exercise as self-care measures (Couser et al., 2020).
Job Stress, Satisfaction, and Burnout
The purpose of the source is to observe the relationship between job satisfaction, job stress, and job burnout among nursing professionals since the problem is significant in the emergency context (Tavakoli et al., 2018). The theoretical framework used is the Maslach Burnout Inventory (MBI), but no interventions are applicable for the source. The sample size is equal to 788 (n=788) nurses, and the setting factor involves Tehran, Iran. Data was collected through a questionnaire with relevant characteristics, such as “age, sex, marital status, education level, employment type and work experience” without a use of control group (Tavakoli et al., 2018, p. 2). The statistical tests were based on one-way ANOVA conducted on SPSS software version 21. The findings show that burnout and job stress are directly correlated, and contributing factors include marital status and job satisfaction. The data is statistically significant with p scores equal to p ≤0.001 (Tavakoli et al., 2018).
Recommendation for Evidence-based Practice
PICO: Nursing professionals (P) should receive empowerment and self-care interventions (I) through workplace policies and training to address the nursing burnout, which leads to reduced patient safety, decreased organizational performance, and low workplace satisfaction (C), because these interventions result in workload reduction, improved coping strategies, higher resilience, and less emotional exhaustion (O) through better management of internal resources.
A similar practice to increase empowerment should be applied in the current workplace environment. As follows from the sample study, psychological empowerment is a potentially useful practice that can be recommended for experimental application within the selected focus group. In this case, the population should be nurses from all gendered ages and social categories. The above research proves that although the causes of burnout may be different, in general, psychological empowerment has a positive effect without exception. The intervention to combat the problem, therefore, consists in the application of psychological empowerment tactics through the development of leadership qualities independent or collective decision-making. In comparison with the current situation, aspects of both independence and collaboration between employees will be emphasized – higher authorities will encourage independent initiatives to a greater extent.
The study uses an evidence-based model informed by the Plan-Do-Study-Act principle. The first stage includes the preparation of theoretical literature and the assembly of a similar statistical apparatus. The second stage includes the application of stimulating psychological practices to the entire selected range of nurses in the current workplace, with the recording and categorization of data about them. The third stage is the study of information, which prompts the fourth stage – the subsequent introduction of empowerment practices into the ongoing activities of this institution.
Conclusion
In conclusion, as a result of such evidence-based intervention, the motivation, self-determination, and internal sufficiency of medical workers should increase. Using the PICO model, it is demonstrated that practices to increase empowerment and reduce the consequences of burnout can be applied in a relevant medical environment. This practice, with proper recording and interpretation of results, can qualitatively transform the field of nursing, bringing to it a greater sense of satisfaction and safety.
References
Couser, G., Chesak, S., & Cutshall, S. (2020). Developing a course to promote self-care for nurses to address burnout. OJIN: The Online Journal of Issues in Nursing, 25(3), 1-19.
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18(1), 1-17.
Garcia, C. L., Abreu, L. C., Ramos, J., Castro, C., Smiderle, F., Santos, J., & Bezerra, I. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina, 55(9), 553-566.
Katulka, L. (2021). Nurse burnout: Statistics & tips for preventing yourself from burning out, too. Berxi.
Ling, K., Xianxiu, W., & Xiaowei, Z. (2020). Analysis of nurses’ job burnout and coping strategies in hemodialysis centers. Medicine, 99(17), 1-4.
Permarupan, P. Y., Mamun, A. A., Samy, N. K., Saufi, R. A., & Hayat, N. (2019). Effect of psychological empowerment on nurses’ burnout. The Open Nursing Journal, 13, 282-291. Web.
Tavakoli, N., Shaker, S. H., Soltani, S., Abbasi, M., Amini, M., Tahmasebi, A., & Hosseini Kasnavieh, S. M. (2018). Job burnout, stress, and satisfaction among emergency nursing staff after health system transformation plan in Iran. Emergency, 6(1), 1-6.