PICOT Question and Literature Search

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38

Relationship among Nurses Role Overload, Burnout and Managerial Coping Strategies at Intensive Care Units

Fatma Rushdy Mohamed

Assistant Professor, Nursing Administration, Faculty of Nursing, Assiut University, Egypt

ABSTRACT

Aim: was to investigate relationship among nurses role overload , burnout and managerial coping strategies at Intensive Care Units in Assiut University Hospital Se� ing & Subjects: Included all nurses working in Causality, General & Postoperative Intensive Care Units and Coronary Care Unit in Assiut University Hospital:. Tools: Four tools which includes Socio-demographic data sheet, role overload questionnaire, managerial coping strategies & burnout questionnaires. Results: Showed that role overload had highest mean score in General and Casuality ICUs. In addition, coping strategies had highest mean scores of rational problem solving , resigned distancing, and seeking support/ ventilation in Casuality and post operative ICUs respectively except passive wishful thinking had highest mean scores in General and Casuality ICUs respectively. Also, burnout had highest mean scores in post operative and general ICU. Conclusions: Nurses employed at ICUs in Assiut University Hospital reported high burnout and use managerial coping strategies as rational problem solving, resigned distancing, seeking support/ventilation and passive wishful thinking to handle burnout and role overload except passive wishful thinking coping strategy not used with role overload.

Keywords: Coping strategies, nurses, role overload, burnout, Intensive Care Units.

INTRODUCTION

Nurses having an important role in the health care system. They are considered to be members of a stressful job as a profession because they care for a stressful group comprising patients or those at health risk(1). When a professional is aff ected by burnout they feel drained and used up and have li� le desire to return to work the next day. It is generally perceived that Intensive Care Nurses are particularly exposed to burnout since they literally deal with life and death situations most of the time. Therefore, it is suggested that nurses comprise the group that experiences the maximum stress, and burnout among health professionals. Burnout syndrome often occurs as a result of chronic work stress seen in Intensive Care Units (2).

Burnout as a phenomenon is defi ned as “a syndrome of emotional exhaustion, cynicism and reduced professional effi cacy”. Researches suggest that burnout contributed to job stressors is associated with a negative outcome in both individuals and organizations (3).

Coping behavior is a constantly changing cognitive and behavioral eff orts to manage specifi c external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Coping behavior aff ects well-being and adaptation. There is a growing understanding that coping strategies, play an important role in infl uencing the tangible and intangible outcomes of the stressor (4).

Coping strategies may have a moderating eff ect on the relationship between the stressor and its consequential strain. Role overload may be regarded as a form of stressor, and burnout is one relevant stress reaction (i.e. strain), coping strategies are therefore likely to have a moderating eff ect on the relationship between role overload and burnout (5).

Signifi cance of the study

Nursing is a sensitive job which includes communicating with patients and caring after them. The provision of Intensive Care can lead to a health care provider’s physical, psychological and emotional exhaustion, which may develop into burnout.

DOI Number: 10.5958/0974-9357.2016.00044.1

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40 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 41

The researcher noticed that there were no specifi c studies regarding burnout syndrome done in Assiut University Hospital. So, the researched decided to investigate the relationship among nurses role overload, burnout and managerial coping strategies at Intensive Care Units in Assiut University Hospital.

AIM

Was to investigate relationship among nurses role overload, burnout and managerial coping strategies (i.e. rational problem solving, resigned distancing, seeking support/ventilation and passive wishful thinking) at Intensive Care Units in Assiut University Hospital.

Research question

• Is there a relationship between managerial coping strategies and nurses role overload and burnout?

SUBJECTS AND METHODS

Study design: A descriptive design was used.

Se� ing: The study was carried out at four Intensive Care Units in Assiut University Hospital named : Causality ICU, General & Postoperative ICUs, and Coronary Care Unit (CCU).

Subjects

Includes all nurses working in aforementioned se� ings with a total number of 100 nurses.

Tools of data collection

Four tools were used to collect data for this study as follows:

• 1st tool :Socio-demographic data sheet:

This part included age, sex , unit name, marital status, educational qualifi cation, and years of experience.

• 2ndtool :Role overload questionnaire which developed by Harris and Bladen (6), it included fi ve items. The Scoring system was fi ve-point Likert-scale ranging from “strongly disagree” (1) to “strongly agree” (5).

• 3rd tool :Managerial coping strategies

questionnaire which developed by Chan(7), it included twenty nine items classifi ed into four factors. rational problem solving, resigned distancing, seeking support/ventilation and passive wishful thinking. The Scoring system was four-point ranging from “not used” (0) to “ used a great deal” (3), and

• 4th tool :Burnout questionnaire which developed by Maslach et al.,(8)), it included twenty two items. The Scoring system was fi ve-point Likert- scale ranging from “Not important” (1) to “More important” (5).

- Their reliability was assessed in a pilot study by measuring their internal consistency using Cronbach’s alpha coeffi cient method. This turned to be 0.88 for coping strategies , 0.90 for burnout , and 0.96 for role overload, thus indicating a high degree of reliability. The validity was measured by fi ve experts in the fi eld of Nursing Administration.

Pilot study

The pilot study served to test the feasibility, clarity and practicability of the data collection tool. It was carried out on 20 nurses from diff erent inpatient departments in Assiut University Hospital. The pilot study collected on April 2015. The subjects included in the pilot study were excluded. Data collected from the pilot study were reviewed and no modifi cations done for the study tools

Fieldwork

An offi cial permission was obtained from the hospital director, the nursing service director, and the head of each Intensive Care Unit before embarking on the study. The actual data collection was started in June 2015 and ended in July 2015. The researcher met the eligible nurses, explained to them the purpose of the study, and asked them for their oral consent to participate. Those who agreed to participate were given the tools and asked to fi ll them out and return them anonymously in the same se� ing or at most the next day.

Ethical Considerations : The study protocol was approved by the pertinent authority. Participants’ oral consent to participate was obtained after informing them about their rights to participate, refuse, or withdraw at any time. Total confi dentiality of any obtained information was ensured. The study

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40 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 41

maneuver could not entail any harmful eff ects on participants.

Statistical analysis

Data entry and statistical analysis were done using SPSS 16.0 statistical software package. Data

were presented using descriptive statistics. Pearson correlation analysis was used for assessment of the inter-relationships among quantitative variables, and Spearman rank correlation for ranked ones. Statistical signifi cance was considered at p-value <0.05.

RESULTS

Table (1): Socio-demographic characteristics of studied nurses (n=100)

Frequency Percent

Age (years):

<30 79 79.0

30-35 14 14.0

>35 7 7.0

Mean±SD 25.28±0.58

Department:

Post operative ICU 20 20.0

General ICU 29 29.0

CCU 30 30.0

Causality ICU 21 21.0

Sex:

Male 2 2.0

Female 98 98.0

Marital status:

Single 50 50.0

Married 46 46.0

Divorced 3 3.0

Widow 1 1.0

Educational qualifi cations:

Nursing Secondary school 44 44.0

Technical Institute of Nursing 33 33.0

Bachelor degree of Nursing 23 23.0

Experience years:

<5 51 51.0

5-10 31 31.0

>10 18 18.0

Mean±SD 4.79 ±0.79

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Table (2): Mean scores of role overload, managerial coping strategies , and burnout among studied nurses at ICUs (n=100)

Study Variables

Mean + SD

Post operative ICU General ICU Coronary Care Unit Causality ICU

- Role overload 15.50±2.43 16.51±3.18 15.30±3.21 15.71±3.18

- Managerial Coping strategies -Rational problem solving

33.50±7.68 30.37±6.52 30.96±6.71 34.80±4.08

-Resigned distancing 10.55± 0.32 10.27±2.76 10.43±2.67 11.42±2.35

-Seeking support/ventilation 14.50±3.76 14.06±3.53 14.10±3.34 15.23±3.40

-Passive wishful thinking 12.20±3.90 12.68±3.08 11.46±2.80 12.28±3.63

- Burnout 66.30±14.54 63.17±14.72 60.90±12.89 57.38±15.23

Table (3): Correlation of role overload, managerial coping strategies , and burnout among studied nurses at ICUs (n=100)

Variables

Pearson correlation coeffi cient

Scores

Role overload Managerial Coping strategies Burnout

Role overload 0.13 0.16

Managerial coping strategies 0.13 0.49**

Burnout 0.16 0.49**

Table (4):Correlation matrix for scores of role overload, coping strategies, burnout and socio-demographic characteristics of ICUs nurses(n=100)

Characteristics

Spearman rank correlation coeffi cient

Role overload

Scores of managerial coping strategies Rational problem solving

Resigned distancing

Seeking support/ ventilation

Passive wishful thinking

Burnout

Age# 0.04 -0.03 -0.09 -0.08 -0.12 -0.13

Marital status ( reference single) 0.02 -0.23* -0.18 -0.19 -0.26** -0.02

Qualifi cation (reference: diploma) -0.14 0.37** 0.04 0.20 0.07 -0.02

Experience years 0.05 -0.06 0.04 -0.08 -0.23* -0.14

Role overload ----- 0.10 0.14 -0.01 0.07 0.49**

Burnout 0.49** 0.34** 0.23* 0.32** 0.45** -----

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(#) Pearson correlation coeffi cient (*) Statistically signifi cant at p<0.05 (**) Statistically signifi cant at p<0.001

Table (1): Illustrated that more than three quarters of study subjects were aged less than 30 yrs and more than one quarter worked at Coronary Care Unit , 98% were females and half of them were single. While, 44% had a diploma degree and more than half of the study subjects had less than 5 years of experience.

Table (2): Showed that role overload had highest mean score in general ICU followed by Casuality ICU (16.51±3.18 & 15.71±3.18) . In addition, managerial coping strategies highest mean scores of rational problem solving , resigned distancing, and seeking support/ventilation were in Casuality ICU followed by post operative ICU ( 34.80±4.08 & 33.50±7.68 ; 11.42±2.35 & 10.55±0.32; and 15.23±3.40 & 14.50±3.76) respectively except passive wishful thinking had highest mean scores in General ICU followed by Casuality ICU (12.68±3.08 & 12.28±3.63).Also, burnout had highest mean scores in post operative ICU followed by general ICU (66.30±14.54 & 63.17±14.72) respectively.

Table (3): Illustrates that burnout had positive relations with managerial coping strategies with a highly statistically signifi cant diff erences (r = 0.49**(. While, there were no relation between role overload & burnout (0.16) and role overload & coping strategies (0.13).

Table,(4): Demonstrates that burnout had positive relations with role overload , rational problem solving, resigned distancing, seeking support/ventilation and passive wishful thinking coping strategies with a highly statistically signifi cant diff erences (r = 0.49** , r = 0.34** , r =0.23* ,r = 0.32**, and r = 0.45**) respectively. While, role overload had weak negative statistically signifi cant correlation with qualifi cations (r= -0.14). In addition, burnout had weak negative correlations with age, marital status, educational qualifi cations, and years of experience (r= 0.13, r= -0.02, r= -0.02& r= -0.14) respectively. Also, rational problem solving coping strategy had weak negative statistically signifi cant correlations with age, marital status, and years of experience (r= -0.03, r= -0.23, & r= -0.06) respectively. Role overload had positive relations with rational problem solving, resigned distancing, and passive wishful thinking

managerial coping strategies ( r = 0.10, r = 0.14 & r = 0.07) respectively except seeking support/ventilation coping strategy had a negative relation with role overload (r = -0.01).

DISCUSSION

The results of the present study showed that role overload had highest mean score in general ICU followed by Casuality ICU . Also, burnout had highest mean scores in post operative ICU followed by general ICU respectively (Table, 2). These results indicated that nurses working in the intensive care unit and coronary care unit experienced lower levels of personal accomplishment and high level of stress and burnout due to these nurses face more death while exert more eff orts so nurses use coping strategies to overcome the eff ects of job stress and burnout.

These results is supported by Chang, Bidewell,& Huntington (9) ; Lin, Probst &Hsu (10) who found that type of coping strategy was signifi cantly associated with physical and mental health, after controlling for the eff ects of job stress. In addition, Gunusen & Ustun (11) reported that burnout among nurses is reduced when coping skills training was provided. Nurses with habitual passive coping may experience li� le control over work and low support within the nursing team(12). While, Spooner-Lane & Pa� on (13)

found that burnout may develop in the individual as a result of a long duration of the state of stress.

The results of the current study demonstrates that burnout had positive relations with role overload and diff erent types of managerial coping strategies with a highly statistically signifi cant diff erences (Table,3&4). These results might be a� ributed to the work in the ICUs is hard than other general units because nurses in ICU provide intensive care for a long period (12 hours) shift and after that patients may died so these situation is stressful and lead to burnout. These results supported by Lashonda (14) who mentioned that nurses when experiencing great stress, draw upon various coping strategies, and their manner of coping with stress, burnout and role overload infl uences the quality of their professional performance. In the same line , GrusiFarshi & Moslemi (15) clarifi ed that one of the important factors in avoiding burnout is applying coping strategies.

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As shown in (Table,4) burnout and rational problem solving coping strategy had weak negative correlations with age, marital status, educational qualifi cations, and years of experience. Role overload had positive relations with rational problem solving, resigned distancing, and passive wishful thinking coping strategies except seeking support/ventilation coping strategy had a negative relation with role overload. These results might be a� ributed to most of the studied nurses are young aged female with limited years of experience, so they had not the ability to use the support /ventilation coping strategy and may be unable to communicate eff ectively which may refl ected on their performance. In addition, women continue to do multiple roles, including those roles related to the home and family, for which the women may have sole or major responsibility. These fi ndings were inconsistent with Foster(16) who found that older nurses experienced a lower level of burnout in emotional exhaustion, depersonalisation, and reduced personal accomplishment than younger nurses.

In addition, Xie , Zhang , Zheng et al., (17)& Bao , Liu & Wu (18)found that Chinese nurses apply diff erent coping strategies, such as wishful thinking, planned problem-solving, to deal with diff erent stressors, and apply avoidance strategies to cope with stress, burnout resulting from the shortage of resources, role overload and interpersonal relationships.

CONCLUSION

• Nurses employed at ICUs in Assiut University Hospital reported high burnout and use managerial coping strategies as rational problem solving, resigned distancing, seeking support/ventilation and passive wishful thinking to handle burnout and role overload except passive wishful thinking coping strategy not used with role overload.

RECOMMENDATIONS

• Developing and implementing a training program on managerial coping strategies to assist nursing staff in health service institutions in Egypt to cope with burnout and role overload eff ectively.

• Further researches should be done to investigate relations among job satisfaction, job stress, personality traits and burnout among ICU staff .

Acknowledgement : The researcher want to acknowledge the study participants.

Source of Funding: Self Self Self

Confl ict of Interest: Nil

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