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Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
BURNOUT AND ITS INTERFACE WITH PATIENT SAFETY BURNOUT E SUA INTERFACE COM A SEGURANÇA DO PACIENTE
BURNOUT Y SU INTERFAZ CON LA SEGURIDAD DEL PACIENTE Edenise Maria Santos da Silva Batalha1, Marta Maria Melleiro2, Elisabete Maria das Neves Borges3
ABSTRACT
Objective: it was sought to analyze scientific articles of the last ten years that address the relationship of Burnout in nursing workers with patient safety. Method: this is a descriptive bibliographical study, an integrative literature review developed in the EBSCOhost and in the Virtual Health Library from November to December, 2018. A critical analysis of the articles was performed and the results were presented in the form of figures. Results: ten articles were included in the review. It was noted that higher levels of Burnout were associated with lower levels of patient safety and with adverse events. Burnout was also associated with lapses in adherence to infection control and mediated the association between depressive symptoms and perception of patient safety. Strong Burnout was negatively associated with time- pressure at work and patient safety. Conclusion: there was a negative association between Burnout in nursing and patient safety. Emphasis should be placed on organizational and personal measures to prevent and minimize Burnout. Descriptors: Professional Burnout; Patient Safety; Nursing; Health; Occupational Health; Quality of Health Care.
RESUMO
Objetivo: buscou-se analisar artigos científicos dos últimos dez anos que contemplassem a relação do Burnout em trabalhadores de enfermagem com a segurança do paciente. Método: trata-se de estudo bibliográfico, descritivo, do tipo revisão integrativa da literatura, desenvolvido na EBSCOhost e na Biblioteca Virtual em Saúde, no período de novembro a dezembro de 2018. Realizou-se a análise crítica dos artigos e os resultados foram apresentados em forma de figuras. Resultados: incluíram-se na revisão dez artigos. Notou-se que níveis mais altos de Burnout estiveram associados a níveis mais baixos de segurança do paciente e a eventos adversos. O Burnout esteve associado também a lapsos na adesão do controle de infecções e mediou a associação entre os sintomas depressivos e a percepção de segurança do paciente. Associou-se negativamente o alto Burnout com a pressão de tempo no trabalho e a segurança do paciente. Conclusão: evidenciou-se associação negativa entre Burnout na enfermagem e segurança dos pacientes. Devem-se enfatizar medidas no âmbito organizacional e pessoal a fim de prevenir e minimizar o Burnout. Descritores: Esgotamento Profissional; Segurança do Paciente; Enfermagem; Saúde; Saúde do Trabalhador; Qualidade da Assistência à Saúde.
RESUMEN
Objetivo: se intentó analizar artículos científicos de los últimos diez años que abarcasen la relación del Burnout en trabajadores de enfermería con la seguridad del paciente. Método: se trata de un estudio bibliográfico, descriptivo, del tipo revisión integradora de la literatura, desarrollado en la EBSCOhost y en la Biblioteca Virtual en Salud, en el período de noviembre a diciembre de 2018. Se realizó el análisis crítico de los artículos y los resultados se presentaron en forma de figuras. Resultados: se incluyeron diez artículos en la revisión. Se notó que niveles más altos de Burnout estuvieron asociados a niveles más bajos de seguridad del paciente y a efectos adversos. El Burnout estuvo asociado también a lapsos en la adhesión del control de infecciones e intermedió la asociación entre los síntomas depresivos y la percepción de seguridad del paciente. Se asoció negativamente el alto Burnout con la presión de tiempo en el trabajo y la seguridad del paciente. Conclusión: se evidenció una asociación negativa entre Burnout en la enfermería y seguridad de los pacientes. Se deben subrayar medidas en el ámbito organizacional y personal con miras a prevenir y mitigar el Burnout. Descriptores: Agotamiento Profesional; Seguridad del Paciente; Enfermería; Salud; Salud Laboral; Calidad de la Atención de Salud. 1University of the State of Bahia, Department of Life Sciences/UNEB. Bahia (BA), Brazil. ORCID : http://orcid.org/0000-0003-0014-9529 Email:
[email protected] 2University of São Paulo, School of Nursing/USP. São Paulo (SP), Brazil. ORCID : http://orcid.org/0000-0002-8835-406X
Email: [email protected] 3Higher School of Nursing of Porto/ESEP. Porto, Portugal. ORCID : http://orcid.org/0000-0002-6478-1008 Email:
How to cite this article Batalha EMSS, Melleiro MM, Borges EMN. J Nurs UFPE on line. Rev enferm UFPE on line. 2019;13:e239641 DOI: https://doi.org/10.5205/1981-8963.2019.239641
INTEGRATIVE LITERATURE REVIEW ARTICLE
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
Patient safety in health services is currently
discussed and encouraged because it is one of the
main components of quality care. Efforts and
management and care strategies for
implementation of patient safety are growing. In
this context, health workers are the main actors
responsible for implementing in their professional
practice the policies, procedures, standards, and
routines to assist patients with safety and quality.
Nursing workers stand out among this group
because they are in great numbers within the
institutions and often provide direct and
continuous care to patients. It is noted that for
these workers to act safely they must be in
physical and psychological balance. However,
physical and emotional stress related to the work
process may lead these workers to experience
situations of suffering, which may hamper or even
prevent their safe performance in the care
provided.1
Burnout syndrome is among the problems that
can emerge in the work context of these
professionals. It is characterized as a psychological
syndrome that implies a prolonged response to
chronic interpersonal stressors in the work
composed of three dimensions: emotional
exhaustion; depersonalization; and personal
accomplishment.2
The dimensions are defined as follows: 1 -
Emotional exhaustion represents the component
related to the basic individual stress of Burnout,
the feeling of overload, and lack of emotional and
physical resources. The workers feel weakened
and without any source of replacement of energy;
2 - Depersonalization is related to the component
of the interpersonal context of Burnout, being a
negative response that makes the worker
insensitive and excessively apathetic to various
aspects of work; 3 - Reduction of personal
accomplishment at work represents the self-
assessment component of Burnout. It refers to
feelings of incompetence and lack of achievement
and productivity at work; the worker questions his
choice of career and has doubts about the
professional he has become, even developing
negative ideas about himself and other
colleagues.2
Burnout is associated with feelings of
hopelessness and difficulty in dealing with work or
doing the work effectively. Such negative feelings
usually have a gradual onset, and may cause the
feeling that the person's efforts make no
difference. It is a combination of chronic
exhaustion and negative attitudes towards work,
with harmful consequences for the worker's health
and productivity, being an important moderator of
daily performance.3 Furthermore, Burnout is
associated with work overload, an non-supportive
and low-resource working environment.1,4
The prevalence of Burnout has been estimated
in some studies in Brazil, with results ranging from
5.9% in nursing technicians in the hospital area,5
17% in intensive care nursing teams,6 7.1%7and
54.2%8 in primary care nursing teams, reaching
values of 82.7% among urgency and emergency
nurses.9 It is demonstrated, therefore, that
although Burnout happens in a heterogeneous way,
it is a reality in nursing and requires attention in
order to preserve the health of the workers and
guarantee the quality of care.
The impact of this syndrome on the physical
and mental health of workers does not pass
unnoticed; Burnout is associated with unhealthy
behaviors such as increased consumption of fast
food, infrequent exercise, increased alcohol
consumption, and more frequent use of
analgesics.10 Furthermore, the prevalence of this
syndrome is positively associated with headache
and dizziness.11
In view of the physical and emotional changes
deriving from Burnout and its consequences for
the quality of care, it is imperative to analyze its
relationship with patient safety. This research is
relevant to the understanding of the phenomenon
and to subsidize intervention proposals and
improvements in workers' health and quality of
care.
● To analyze scientific articles of the last ten
years addressing the relationship of Burnout in
nursing workers with patient safety.
This is a descriptive, bibliographical study of
the integrative review type.12-3 The following six
steps were adopted: 1-Delimitation of the theme
and formulation of the research question; 2 -
Sampling or search in the literature, selection of
studies; 3 - Categorization of studies through a
previously repared instrument; 4 -Critical analysis
of the included studies; 5 - Interpretation of
results; and 6 - Presentation of the synthesis of
the review, showing the main results.13
The following research question was
established: What is the relationship between
Burnout in nursing workers and patient safety?
Data were collected from November to
December 2018 through all the databases of
EBSCOhost and the Virtual Health Library (VHL)
with access to the Latin American and the
Caribbean Literature in Health Sciences (LILACS)
and the Scientific Eletronic Library Online (SCIELO)
and other databases inserted in the VHL/BIREME
that presented articles meeting the inclusion
criteria of this review.
The following descriptors were used: "patient
safety", "burnout" and "nursing" combined with the
Boolean operator AND. In order to expand the
INTRODUCTION
OBJECTIVE
METHOD
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
search, the terms referring to the dimensions of
Burnout were also used: "emotional
exhaustion","Depersonalization","personal
accomplishment", also combined with "patient
safety" and "nursing" through the Boolean operator
AND.
The selection criteria for inclusion of articles
were: original articles, available in full length,
published in English, Portuguese and Spanish from
2008 to 2018, meeting the objective of this
review. The exclusion criteria were: review
articles, editorials, articles of reflection, and
theoretical studies.
The intersection of descriptors using the filters
language, study period, and availability for
download resulted in 227 articles in EBSCOhost
and 134 articles in the VHL, totaling 361 articles.
A careful reading of titles, abstracts and keywords
was done. Articles repeated in both databases and
not meeting the objective of this research were
excluded. Thus, a total of 351 articles were
excluded. Therefore, 10 articles were included in
the integrative review. The flowchart of the
stages of the integrative review is shown in Figure
1.
Figure 1. Flowchart of identification, selection, eligibility, and inclusion of studies in the integrative review. Porto,
Portugal, 2018.
An instrument was created Microsoft Excel by
the authors for collection of information as a
method to organize and tabulate the data, and
later critical analysis. The instrument had the
following items: title; year of publication; journal
of publication; place of publication; goals;
methodology (the methodological trajectory was
evaluated through analysis of rigor of the
methods, interventions, and procedures adopted
for data collection and analysis, and level of
scientific evidence); main results; and conclusions.
The articles were analyzed critically and the
results were summarized, highlighting the
relationship between Burnout in nursing workers
and patient safety in health care. The results were
presented by means of figures.
The studies included in this review are
presented in the Figure 2 according to the title;
year; place; journal; and language of publication.
RESULTS
Items identified through searches in the databases (n = 361)
Items after elimination of duplicate studies (n = 345)
Excluded studies (n = 329)
Studies selected for reading in full length
(n = 16)
Complete studies evaluated for
eligibility (n = 16)
Full length studies excluded
(n = 6)
ID E N
T IF
IC A
T IO
N
Studies included in the qualitative
synthesis (n = 10)
E L IG
IB IL
IT Y
S E L E C
T IO
N
IN C
L U
S IO
N
Studies included in quantitative
synthesis (n = 0)
Items identified through surveys in other data sources (n = 0)
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
It was noted that most of the studies were published in English and in the year 2017.
Title/Year Local/Newspaper/Language
1 - Nurse burnout and patient safety outcomes nurse safety perception versus reporting behavior/2008.14
Canada/ Western Journal of Nursing
Research/English 2 - Interactive effects of nurse-experienced time pressure and burnout on patient safety: A cross-sectional survey/2010.15
Taiwan/ International Journal of Nursing
Studies/English 3 - Work environment and patient safety: comparison of data between the studies SENECA and RN4CAST/2013.16
Spain Clinical Nursing/Spanish
4 - Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey/2014.17
International Journal of Nursing Studies/English
5 - Safety climate, emotional exhaustion and job satisfaction among Brazilian paediatric professional nurses/2016.18
Brazil/International Nursing Review/English
6 - The association between patient safety culture and burnout and sense of coherence: A cross-sectional study in restructured and not restructured intensive care units/2016.19
Norway/Intensive and Critical Care Nursing/English
7 - Job burnout reduces hand hygiene compliance among nursing staff/2017.20
Greece/Journal Patient Safety/English
8 - Burnout mediates the association between symptoms of depression and patient safety perceptions: A cross-sectional study in hospital nurses /2017.21
United Kingdom/Journal of Advanced Nursing/English
9-Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses/2017.22
Ecuador/ International Nursing Review/English
10 - Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis/2018.23
China/ International Journal of Nursing
Studies/English
Figure 2. Description of articles included in the review according to title; year; place; journal; and language of publication. Porto, Portugal, 2018.
The articles included in this review are
described in Figure 3 according to the objectives;
type of study; main results; and conclusions.
Main objective/Type of study Main Results and Conclusions
1 - To explore the relationship between Burnout and perceptions about patient safety, adverse events, and near-miss notification behaviors. Cross-sectional study.14
The dimensions of Burnout were negatively associated with the degree of patient safety, suggesting that the highest Burnout level was associated with a low degree of patient safety. Burnout was negatively associated with near-miss notification frequency; however, no Burnout component was associated with the number of events reported in the previous 12 months.
2 - To investigate how time-pressure and its interaction with burnout affect patient safety. Cross-sectional study.15
Patient safety was negatively related to time-pressure in the group presenting high burnout. It was evidenced that nurses under strong time-pressure and high level of Burnout are probably affected in relation their performance with respect to patient safety.
3 - To analyze the relationship between
the work environment, Burnout of nurses, and the quality of care related to patient safety in hospitals of the Unified Health System of Spain, included in the SENECA and RN4CAST studies. Descriptive study with secondary analysis of data obtained in the SENECA and RN4CAST studies.16
The perception of safety of care by professionals was related to Burnout syndrome in the dimensions of emotional exhaustion and depersonalization. It is emphasized that organizations that promote a more supportive work environment will have patients who feel safer and the proper management of resources can reduce the occurrence of adverse events.
4 - To investigate the impact of the work environment, characteristics of the nursing work and Burnout on nursing outcomes, quality of care, and adverse events for patients. Cross-sectional study.17
Perceptions about quality of care in the hospital unit in the last shift and in the last year were related to the three dimensions of Burnout. Nosocomial infections were associated with the three dimensions of Burnout, with falls and medication errors being associated with the dimensions of emotional exhaustion and depersonalization.
5 - To evaluate the correlation and predictive effect of emotional exhaustion and job satisfaction on safety climate and quality of care. Cross-sectional study.18
It was found that the lower the level of emotional exhaustion, the more positive was the perception of safety climate and the greater was the job satisfaction. The effects that professional exhaustion can have on patient safety were demonstrated, and higher levels of emotional exhaustion of professionals lead to worse patient safety.
6 - To investigate associations between perceptions of safety culture in Intensive Care Units and Burnout and sense of coherence. Cross-sectional study.19
Positive safety culture was correlated with low Burnout scores and a strong sense of coherence.
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
7 - To analyze whether Burnout reduces adherence to handwashing among nursing staff. Daily study conducted with a mixed method approach (questionnaires and observation).20
Burnout was negatively associated with adherence to hand hygiene; nurses who reported high levels of Burnout were less likely to comply with hand hygiene opportunities.
8 - To investigate the relations between depressive symptoms, Burnout , and perceptions of patient safety. Cross-sectional study.21
The dimensions of emotional exhaustion and depersonalization were associated with perceptions of patient safety. It was also evidenced that Burnout mediated the association between depressive symptoms and perception of patient safety both individually and at the level of work area/unit.
9 - To examine the association between effort-reward imbalance, Burnout , and adherence to infection control measures. Correlational, cross-sectional study.22
The study found that Burnout was associated with lapses in adherence to infection control measures, which may result in increased infections, threatening the health of both the workforce and the populations they assist.
10 - To explore the impact of the work environment, workload, non-realized care measures, and Burnout on patient safety. Cross-sectional study.23
A better working environment was associated with lower Burnout, which was subsequently related to a higher level of patient safety and fewer adverse events.
Figure 3. Description of the articles according to objectives; type of study; main results; and conclusions. Porto, Portugal, 2018.
A summary of relevant points of the articles
included in this review is presented in Figure 4,
showing the relationship between Burnout and
aspects of patient safety (PS) in health
institutions.
Figure 4. Relational Interface between Burnout in Nursing workers and Patient Safety (PS). Porto,
Portugal, 2018.
The relationship between Burnout and patient
safety was clearly demonstrated in the studies.
Highest Burnout levels were associated with a low
degree of patient safety14 and in contrast, a
positive patient safety culture was correlated with
low scores of patient safet.19 Yet, the lowest
levels of emotional exhaustion were related to the
perception of the most positive patient safety
climate18 and perceptions about the quality of
care were associated with the three dimensions of
Burnout.17
These findings can be seen in two ways; first,
because of aspects of Burnout, nursing workers
could be more prone to lower compliance with
quality standards, consequently generating more
errors and adverse events, and therefore leading
to the provision of care with lower patient safety.
Secondarily, the results may suggest the other way
around, that because nursing workers are in a
working environment with low patient safety, they
present higher levels of Burnout. In this regard,
the relationship can be cyclical and interventions
must be implemented in order to guarantee the
elimination or lower levels of burnout, and higher
levels of safety.
A better working environment was associated
with lower Burnout, which was subsequently
related to a higher level of patient safety and
fewer adverse events. Emphasis should therefore
be given to the importance of improving the work
environment so as to help to reduce Burnout and
promote patient safety.23
It was demonstrated that Burnout may be the
most important variable for patient safety, since it
completely mediated the association between
depressive symptoms and perception of patient
safety. Not only was Burnout associated with
depressive symptoms and perceptions of patient
DISCUSSION
Burnout
Patient safety
- High Burnout level was associated with lower PS levels and lower frequency of near miss reports; - Low level of Burnout was related to a positive culture of PS; the lower the level of emotional exhaustion the more positive was the perception of PS climate; - The dimensions of Burnout were associated with falls, nosocomial infections, and medication errors; - Burnout was associated with lapses in adherence to infection control measures and lower probability to comply with hand hygiene opportunities; - Burnout mediated the association between depressive symptoms and perception of PS; - In high Burnout, time-pressure at work was negatively related to PS; - A better work environment was directly associated with lower Burnout, which was subsequently
related to higher levels of PS and fewer adverse events.
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
safety, but the best statistical fitness was found
when depressive symptoms were considered as a
result of Burnout rather than a predictor of this
condition.21 These results lead to the notion that
Burnout can further increase the risk of depressive
symptoms in nursing workers and that it is a major
mediator of erception of patient safety, both at
the level of individual and unit work. Therefore,
interventions aimed at Burnout are likely most
appropriate for improving patient safety.21
The relationship between Burnout and
depression has been confirmed in other studies,24-
5 pointing to the need to understand which
dimensions of Burnout can influence depression,
and in which manner. It is necessary, from this
understanding, to evaluate which interventions
would be most effective at the level of both
individual and organizational factors.
It was seen that time-pressure at work
adversely affected patient safety in the case of
nurses with a high level of Burnout, but not in
nurses with low levels of the syndrome.15
Time-pressure is recognized as a phenomenon
widely experienced in nursing work that has
substantially negative implications for quality and
safe care. It is imperative to establish a better
support for nurses by investing in staff
development and resource optimization. This
would reduce the circumstances in which nursing
workers are challenged to provide good care under
time-pressure.26
It turns out that nurses experiencing Burnout
showed to have little resources to adhere to their
demands in the workplace, creating a gap
between the necessary and real efforts in patient
care. It was also observed that these nurses had a
greater inability to adapt to time-pressure,
enhancing the probability of errors that negatively
interfere with patient safety.15
Workers with higher levels of Burnout were
associated with fewer near miss reports.14 This
result is worrisome because the prevention of
adverse events is linked to the identification of
near miss events.
The Near-Miss Nursing Model presents an
explanation of how a defective system and human
factors can result in harm to patients if not
intercepted. Three potential sources of error are
included in the model: technical, organizational,
and human failure. Any one of these failures,
isolated or combined, can result in a sequence of
events that, if left uninterrupted, may result in
adverse events. It is now well recognized that
technical and organizational failures are
responsible for a large number of errors.
Nevertheless, the importance of appreciating
human behaviors stands out because they play a
role in generating errors and also in their
vigilance, recovery and prevention.27
It was found that workers with Burnout tend to
report less near misses,14 proving that this human
factor may be fragile in relation to the
recognition, prevention and mitigation of errors,
thus hindering organizational learning and
improvement processes.
It was also found that the dimensions
exhaustion and depersonalization were associated
with falls and medication errors.17
The third worldwide challenge of patient safety
"No-harm Medication" by the World Health
Organization (WHO) was launched in 2017
motivated by the extent and magnitude of errors
related to use of medicines. The goal of this global
challenge was to improve drug safety based on the
fact that medication errors cause preventable
injuries and damages to health systems,
generating an estimated annual cost of $ 42
billion.28
A survey carried out with the participation of
nurses in 2018 revealed that all had witnessed or
experienced errors in the administration of
medication. Most of these events did not cause
harm to the patients, but three nurses reported
that death was the final outcome and pointed out
lack of attention as the main cause of the error.29
The important relation of Burnout with possible
medication errors is noteworthy. Burnout reduces
the effectiveness of workers due to physical and
emotional symptoms, including memory lapses.
A total of 27,339 falls were reported in Brazil
between March 2014 and September 2018.30 Falls
are among the most prevalent incidents in health
services, and can lead to damages to patients that
increase morbidity and mortality.
It was found that lower incidence of falls
resulted from the implementation of preventive
measures, suggesting that the prevention
protocol, the use of a risk assessment scale, the
systematic raising of awareness and guidance to
patients, family members and the nursing staff
may have impacted the occurrence of the event in
the institution.31
It should be emphasized that all measures to
prevent medication errors and falls are relevant.
However, what this review adds is that due to the
association of these types of incidents with the
dimensions of Burnout, it is also necessary to
improve the health of the workers, especially in
relation to emotional exhaustion and
depersonalization.
Burnout was associated with lapses in
adherence to infection control protocols22 and
with lower likelihood to comply with hand hygiene
opportunities.20 It is clear that Burnout interferes
with adherence to prevention measures, thus
becoming a contributing factor to unsafe acts that
lead to risks of infection in both patients and
workers. There is a close relationship between
patient safety and infection control. Many health
care measures to prevent infections focus on
adherence to hand hygiene through an interactive
process of information, training, observation,
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
feedback32, as well as on the education and
awareness of professionals, monitoring compliance
with protocols, and using technologies.33 However,
besides these preventive measures, another need
that deserves attention is care for the worker's
health. Workers experience situations of suffering
and this can prevent them from following
standardizations, leading to more healthcare-
related infections. This has already been
demonstrated; nosocomial infections have been
proved to be related to the three dimensions of
Burnout.17
It is essential to promote the prevention and
minimization of Burnout. Preventive measures
must take into account how this syndrome
develops and which points are essential for its
mitigation.
It is understood that six areas are fundamental
to foment strategies regarding Burnout: 1.
Workload: an amount of demands than are beyond
the worker's ability to manage, generating or
aggravating Burnout; 2. Control: it refers to the
worker's participation in decisions that affect his
work; 3. Reward: recognition for the contributions
of the worker, which influences the vulnerability
to Burnout; 4. Community: the quality of
relationships with others at the workplace, which
plays a central role; 5. Equity: A sense of justice
makes workers to get involved with their
workplaces, while the experience of injustice
exhausts and discourages them, causing them to
set a emotional and physical distance from the
workplace; and finally, 6. Values: when the
worker has a team with which he shares values,
making him feel more energized and motivated.2
Personal measures should be combined with
organizational measures in the plan to relief and
prevent Burnout. Such measures must focus on the
workplace and try to change the conditions that
are actually causing stress when taking into
account work-oriented proposals. This model
includes redesigning tasks, increasing the
acknowledgement of workers, and developing
more fair and equitable policies. The goal is to
change work patterns, such as working less, taking
more breaks, avoiding extra work, balancing work
with the rest of life, and measures related to the
personal level. It also includes the development of
coping skills for conflict resolution and time
management; obtaining social support; using
relaxation strategies; promoting good health and
gymnastics; and developing self-knowledge.2
It should be noted that improvements in
relation to Burnout go through an intense
organizational commitment and personal
involvement of the worker. The need for
knowledge about the syndrome and its prevention
is something that must be highlighted. Poor
knowledge about this topic has been pointed out
by nursing workers.34-5Sometimes, Burnout is
understood only as occupational stress.35 This
information ratifies the need to discuss this
phenomenon in continuing education activities in
health services, seeking to engage the workers and
give them support to deal with Burnout.
The development of Burnout syndrome is
multifactorial and dependent on personal and
organizational aspects. The literature describes,
however, factors such as excessive working hours
and professional dissatisfaction as the main
predictors of this syndrome in nurses. 36 Therefore,
measures are needed to improve these factors and
to promote a better quality of life for workers
and, consequently, greater patient safety.
It was found that Burnout is negatively
associated with patient safety, and research has
revealed critical points that can be affected by
Burnout, including general adverse events,
especially falls, medication errors, and
healthcare-related infections. It was shown that
Burnout can mediate depressive symptoms and
interfere with the relationship of time-pressure at
work, thereby demeaning patient safety.
The association between burnout and the
patient safety culture and climate was evident in
the present study. This calls for the need to
strengthen this relationship and put Burnout
prevention at the center of the intervention
proposals. The health of nursing workers should be
prioritized when patient safety policies are
implemented.
Emphasis is placed on measures at the
organizational level to prevent and minimize
Burnout, particularly on workload and stressful
situations at work. It is also pointed out that
workers should pay attention to this syndrome and
seek measures to prevent and relief the problem
at individual and group level, especially within the
scope of work team.
A low number of articles addressing the theme
of the present study was observed, this fact leads
to believe that although there is a significant
number of studies in the area of Burnout and
patient safety, the relationship between these two
large areas in nursing is still recent and little
explored, thus constituting as a possibility for
further research. Particularly important is the
establishment of causal relations between these
two areas and proposing effective interventions to
improve care, working conditions, and worker's
health.
As limitations of the study, there was the fact
that the articles included had a cross-sectional
design, which means that given portion of the
moment was studied, and implying that the
phenomenon was not followed-up over time in the
researched scenarios. The studies are therefore
limited to expressing the relationship between
Burnout and patient safety only in this temporal
CONCLUSION
Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
interval. In addition, the studies were carried out
in specific contexts and samples, and therefore,
the generalization of the results should be done
with caution.
This work was held with the support of the
Coordination for the Improvement of Higher
Education Personnel – Brazil (CAPES) – Financing
Code 88881.190017/2018-01.
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Batalha EMSS, Melleiro MM, Borges EMN. Burnout and its interface with patient...
J Nurs UFPE on line. 2019;13:e239641
https://doi.org/10.5205/1981-8963.2019.239641
Submission: 2019/01/30 Accepted: 2019/06/03 Publishing: 2019/06/22
Corresponding Address
Edenise Maria Santos da Silva Batalha
Email: [email protected]
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