Abstract
Background: Previous studies have found significant stressors experienced by nurses working in hemodialysis units. The purpose of this study was to determine the burnout levels of hemodialysis nurses working in hemodialysis units and their relation with some sociodemographic variables. Methods: The study was conducted between July 2012 and Sept 2012 in hemodialysis units of four hospitals, including one university, one public and two private hospitals, in the province of Erzurum. The population of the study consisted of 32 nurses rendering service in hemodialysis units of the related hospitals. Information forms, which were prepared by researchers in accordance with the literature, and aimed at determining the personal characteristics of nurses and Maslach Burnout Inventory were used for the data collection. Results: Examining mean scores obtained by nurses from the Maslach Burnout Inventory, it is observed that they scored 17.07 ± 8.29 from subscale of emotional exhaustion, 5.89 ± 4.13 from subscale of depersonalization and 20.64 ± 4.10 from subscale of personal accomplishment. Conclusion: The results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of emotional exhaustion, depersonalization, and a high-level burnout in terms of the subscale of personal accomplishment.
Introduction
Burnout syndrome is a complex phenomenon related to a stressful working environment. It was first described in the mid-1970s by Freudenberg, and ever since it has been the subject of discussion by many studies.Citation1,Citation2 Burnout is a syndrome that can be due to emotional exhaustion, depersonalization and decreased personal accomplishment.Citation3,Citation4 Emotional exhaustion (EE) identified as work-related overload on the person and burnout that can develop following severe physical or psychological tiredness. Depersonalization (DP), which is a symptom of EE, is said to be present when employees treat the persons they employ as objects, use demeaning words and present an uncaring, cynical attitude. Lack of personal achievement (PA) is present when the person evaluates himself/herself negatively, believes he/she is inadequate in various work-related matters and feels unsuccessful in communicating with others in the workplace.Citation3,Citation5 Although burnout has been described and studied within a number of different professional groups, this phenomenon is of special importance for healthcare professional.Citation2,Citation6,Citation7 The reasons for this involve the vitality of health care, restricted time factors, the use of new and dissimilar technologies, interaction with many people and deficiencies regarding job security. As nurses are responsible for the continuous care of patients, they are more vulnerable to burnout. Among nurses, burnout is regarded as a serious problem, not only because it is potentially hazardous to their health, resulting in problems such as physical exhaustion or insomnia, but also because it influences patients’ satisfaction and security. In addition to a decrease in productivity, burnout also causes job dissatisfaction, depression, the neglect of patients and their family, low health care and financial loss.Citation8–11 The literature shows that the issue of burnout has been studied in different areas of nursing, such as oncology, intensive and palliative care, emergency and mental health services and dialysis.Citation8,Citation12–15
Providing care for patients with chronic disease such as end-stage renal disease, working in a technical environment exactly of machines and coping with the increased expectations of patients is stressful. The death of patients following long-term care can also lead to burnout in dialysis unit personnel.Citation16,Citation17 A literature search revealed that the exhaustion levels of physicians, teachers, nurses from various clinics and academics have been studied in Turkey.Citation9,Citation13,Citation18 However, there are few studies that focus on fatigue and burnout in dialysis unit nurses.Citation19–22 It may be possible to prevent the negative effects of these problems by defining, preventing and properly handling stress. The purpose of this study was to determine the burnout levels of hemodialysis nurses working in hemodialysis units and their relation with some sociodemographic variables.
Materials and methods
This cross-sectional and descriptive study was carried out to explore exhaustion and burnout in nurses working in hemodialysis units in Erzurum, Turkey. There are totally four hemodialysis units (including one university, one public and two private hospitals) in Erzurum. The study was conducted between July 2012 and Sept 2012. The population of the study consisted totally of 32 nurses working in hemodialysis units of the related hospitals. A total of 28 nurses agreed to participate in the study; four could not be reached for various reasons. A questionnaire survey was used for this study, distributed to nurses and collected by researchers. The nurses responded at their own convenience.
A questionnaire was distributed consisting of two parts. The first part had questions to determine the demographic features (age, gender, marital status, number of children, work status, type of work) of the participants. The Maslach Burnout Inventory (MBI)Citation2, a self-administered questionnaire, was used to measure burnout in the second part. It was translated into Turkish and its reliability was recalculated.Citation23
Maslach Burnout Inventory
The Maslach Burnout Inventory (MBI) was used to assess levels of staff burnout. The inventory is a 22-item measure that assesses the frequency of occurrence of three aspects of burnout: emotional exhaustion (EE), which is the feeling of being exhausted by one’s work, depersonalization (DP), which involves the development of a detached, callous or even dehumanized response towards others, and personal accomplishment (PA), which is the degree to which one feels that one is achieving and succeeding in one’s work. Higher scores on the EE and DP scales indicate more burnout, while higher scores on the PA scale indicate less burnout. A reliability study that was carried out in Turkey identified no cut-off limit.Citation23
The data was transferred into computer environment by using SPSS 16.0 program (Chicago, IL) and evaluated with percentage, mean, independent samples t test, one way analysis of variance (ANOVA), correlation, Kruskal–Wallis analysis of variance, and Mann–Whitney U test.
Ethical approval
The study received written consent from the chief physician’s office and the nursing services directorate. We also obtained verbal consent from the unit nurses after explaining the aim of the study.
Results
Twenty-eight nurses responded to our questionnaire. They worked in four different hospital hemodialysis units in Erzurum. The participants were 89.3% female and 10.7% male. Their mean age was 28.82 ± 5.75 years, mean weekly working hours were 46.17 ± 4.98 hours and professional life duration was 8.17 ± 5.25 years. The characteristics of the participants were as follows: 60.7% were married; 57.1% had one child; 42.9% had graduated from university; 82.1% held regular meetings with the team; 71.4% had received dialysis-related training.
The MBI score subscales of the nurses provided a mean EE score of 17.07 ± 8.29, DP score of 5.89 ± 4.13 and PA score of 20.64 ± 4.10 ().
Figure 1. Nurses’ mean MBI subscales scores.
Comparing the personal characteristics of nurses and their mean scores obtained from the MBI, it was determined that there was a statistically significant difference between DP and PA with gender; marital status and EE; EE and PA with state of having a child; educational status and EE; DP and PA with the working institution (, p < 0.05), but did not find any association between the professional life duration, weekly working hours, income status and participation in meetings related to hemodialysis with the MBI score (, p > 0.05). Results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of EE and DP, and a high-level burnout in terms of subscale of PA.
Table 1. Nurses’ mean MBI scores by professional characteristics.
Discussion
Occupational burnout is a psychological response to chronic stressors in the workplace such as excessively long workdays, high workloads, and insufficient resources to accomplish the job.Citation24 Over a period of time such work demands become overwhelming, depleting individuals’ emotional and physical resources. Consequently, burnout is characterized by feelings of emotional exhaustion, detachment from others, and diminished perceptions of personal accomplishment.Citation25 Findings from this study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of EE and DP, and a high-level burnout in terms of subscale of PA. When compared with other studies that were conducted among other groups of hemodialysis nurses in Turkey, the EE, DP and PA scores were similar.Citation15,Citation20,Citation21 In studies in the international literature, it is reported that hemodialysis nurses experience EE, DP, and work-related distress.Citation17,Citation26,Citation27
Burnout and the degree to which nursing professionals are impacted depend on many factors, such as their age, gender, and marital status, as well as the duration of professional life and suitability of the job.Citation28,Citation29 For instance on gender, Fahrenkopf et al.Citation30 found that there was no association between gender and burnout,Citation9,Citation31 although another study found that women had a higher risk of burnout.Citation32–34 This discrepancy might have been caused by differences in subjects, instruments, specialties, research methods and countries. In our study, there was a significant difference in burnout by gender.
The average score of the married nurses EE (18.11 ± 6.53) and unmarried nurses (15.45 ± 10.62) was lower (p < 0.05, ). Having a family can increase satisfaction from one field of life and give an individual an aim and a reason to exist, thus positively affecting professional accomplishment. Various studies have reported different results.Citation9,Citation14,Citation23,Citation35
As a result of the study, it was determined that nurses who have children have higher mean scores of EE and lower mean scores of PA, compared to those who do not have children (, p < 0.05). Factors such as age, marital status, having children, gender, personal expectations and desires, personal traits, performance are among personal factors causing the burnout. In their study, Demir et al. determined that mean scores of PA are lower in nurses who have children, compared to those who do not have children.Citation32 Our study results are similar to those of other studies.Citation33,Citation34,Citation36
As a result of this study, it was determined that while the highest mean score of EE belonged to nurses graduated from Health occupational high school, the lowest mean score of EE was obtained by university nurses. Some studies that investigated educational status and burnout showed different results. For example, burnout levels decreased with increasing educational status.Citation32,Citation37 However, other studies demonstrated that there was no association between educational status and the burnout level.Citation9,Citation38,Citation39 Some studies showed that training for conflict might decrease the DP scores among nurses and suggested that increasing educational levels among nurses might translate into more autonomy and job satisfaction in the profession.Citation28,Citation32 Bektas and Ilhan found that improvements in occupational education created higher occupational expectations, which also increased the DP scores.Citation40
As a result of the study, it was determined that nurses working at state hospitals have higher DP mean scores and lower PA mean scores compared to nurses working at private hospitals. This conclusion might be associated with the fact that hemodialysis nurses working at state hospitals work under worse conditions. In their study, Şenturan et al. stated that the feeling of burnout is experienced at university hospitals at the utmost and private hospitals at least.Citation15 In addition, it is indicated that since it is possible to select the intended department in private sector, motivation and job satisfaction are higher.Citation41
We did not find any association between the other factors of professional life duration, weekly working hours, income status and participation in meetings related to hemodialysis with the level of burnout. Other studies have obtained similar and dissimilar results. Some studies have found higher exhaustion levels with increased years of working hoursCitation2,Citation32 while some studies have found the opposite.Citation9,Citation42,Citation43 These varied results may be due to the nurses originating from different fields with different experiences and the personal characteristics of the nurses in the different studies. Increased working hours may increase the work experience of nurses and help them to cope better with negative situations that arise.Citation43
Technology is advancing rapidly at present and dialysis procedures are developing in parallel with the technology. Adapting to this change requires constant training of patients and dialysis unit nurses so that they are updated on new information and procedures. Some nurses in our study had not participation in meetings related to hemodialysis, although we found no association between dialysis training status and exhaustion levels of the nurses.
Conclusion
Results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of EE and DP, and a high-level burnout in terms of subscale of PA. Dialysis unit nurses appeared to be more satisfied with their jobs than those in other units, such as intensive care, therefore, this satisfaction should be encouraged.
Evidence-based strategies must be implemented in health care organizations aimed at reducing the likelihood of nurse burnout. Supportive traits such as staff input into decisions and policies, supportive and competent managers, flexible schedules, continuing education offerings, and efficacious continuing quality improvement activities can and should be implemented in chronic hemodialysis facilities. Establishment of psychosocial support programs for the health Professional seems to be essential.
Lastly, we recommend that this study should be repeated to include a more extensive nursing population and other occupational groups and to survey the physiological effects of burnout among hemodialysis nurses.
The results we obtained from our study have been shared with the executives of the required institutions and these recommendations have been made, which may reduce the exhaustion level of nurses working in the institutions.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
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