RELATIONSHIP BETWEEN BURNOUT AND EMOTIONAL INTELLIGENCE AMONG
HEALTHCARE WORKERS IN KENYATTA NATIONAL HOSPITAL IN KENYA
Background of the Study
Burnout is a condition that depletes an individual of physical and emotional energy and changes
one’s outlook of professional work. The evidence of burnout is emotional exhaustion,
depersonalization, and low professional accomplishment. The individual is naturally fatigued,
mentally disconnected in exemplifying their line of duty – cynical and often inefficient, implying
that their emotions have been affected.
Burnout has neurocognitive impairment implication (Morawetz, Bode, Baudewig, &Heekeren,
2017). Studies by Savic (2015) demonstrated amygdala enlargement on the Magnetic Resonance
Imaging (MRI) scans of respondents who were identified through the Maslach Burnout Inventory
self-report to have burnout and perceived stress. Further, burnout was negatively correlated to
reduced connectivity between the amygdala, the anterior cingulate, and medial prefrontal cortex,
hence weakening the emotional regulation (Morawetz, Bode, Baudewig, &Heekeren, 2017).
Although findings by Danhof-Pont, van Veen, and Zitman (2011) were non-conclusive on changes
in biomarkers due to burnout, studies on the brain and salivary cortisol confirm that a physiological
change occurs when individuals experience burnout (Savic, 2015). Savic (2015) noted that
repeated activation and subsequent changes in the structure of the Amygdala, its connectivity to the
prefrontal cortex interferes with the ability of the individual to modulate emotions, attention, and
memory are affected; while unregulated cortisol levels lead to physiological illnesses. It is
therefore evident that burnout as a phenomenon has a negative impact on individuals’ physical and
psychological state (Dubale et al., 2019).
Burnout, work-related stress, and diminished resiliency have been associated with psychiatric
symptoms like depression, and high-risk behaviors such as substance use or abuse. The presence of
depression has been reported among health workers who had burnout (Lu, Dresden, McCloskey,
Branzetti, & Gisondi, 2015; Smeds et al., 2020). Smeds et al. (2020) further records that the
physicians they interviewed reported having burnout. It was noted that specialists, that included
emergency room specialists had higher burnout levels than their counterparts. This was associated
with substance use, relationship problems, and suicide.
A study done by Rath, Huffman, Phillips, Carpenter, and Fowler (2015) among members of the
Society of Gynecologic Oncology demonstrated a correlation between burnout and depressive
illness, substance abuse, and suicidal ideation. Healthcare workers who experienced compassion
fatigue, which is related to burnout, were found to self-medicate. Ironically, medications that can
be abused are accessible to HCW (Ross, Berry, Smye, & Goldner, 2018).
The World Health Organization categorizes substances of use or abuse, these include alcohol,
tobacco, and other substances of abuse, under the broad classification of psychoactive substances
that, when consumed in any form, affect the brain (World Health Organization [WHO], 2020).
Mainly the processes of basal ganglia, amygdala, and prefrontal cortex are affected among other
areas of the brain. The National Institute on Drug Abuse posits that the limbic reward pathway
hijacks an individual’s brain function whereby cognition, emotions, and affect are interfered with
(National Institute on Drug Abuse [NIDA], 2020). Alcohol and substance use and burnout affect
the brain. This interferes with objective clinical judgment (Pedersen, Sørensen, Bruun, Christensen,
& Vedsted, 2016). Burnout interferes with patient care and interpersonal skills like active listening,
patience, adaptability (Dubale et al., 2019; Kokonya et al., 2014; McKinley et al., 2020; Smeds et
al., 2020).
Burnout also has considerable direct and indirect financial implications. It was cited in the Harvard
Magazine that the cost of doctors’ burnout is $4.6 billion annually (Powell, 2019, para. 1). It costs
Canada an approximate of $ 213.1 million in an early exit from active duty and limited clinical
services (Dewa, Jacobs, Thanh, & Loong, 2014). Various studies in high-income countries
identified burnout among various disciplines in the health sector (McKinley et al., 2020). Findings
following an extensive review of studies involving doctors in 45 countries over the period between
1991 to 2018 reported a high burnout level of 67% among the respondents who completed the self-
administered Maslach Burnout Inventory (Rotenstein et al., 2018). A Loera, Converso, and Viotti
(2014) study showed that nurses also experience burnout. The cost to sub-Saharan Africa and
particularly Kenya is a massive migration of healthcare workers to developed countries (Dubale et
al., 2019).
Closely related to burnout is compassion fatigue described as tension and constant exhaustion at
work (Kabunga, Anyolitho, & Betty, 2020). This study conducted by Kabunga et al. (2020)
indicated that a total of 84% of the 220 participants among physiotherapists in Northern Uganda
experienced an upsurge of compassion fatigue associated with working in a clinical setting.
A report by Kokonya et al. (2014) should be of great concern in Kenyatta National Hospital where
“a crude prevalence rate of burnout syndrome was 95%”. Apparently, there is a growing body of
evidence that suggests burnout and emotional intelligence are linked (Năstasă & Fărcaş, 2015;
Szczygiel & Mikolajczak, 2018). Burnout is a product of workplace emotional pressures, leading
to progressive emotional demoralization and diminishing self-confidence. This relegates efficiency
and quality health care to poor services and staff demotivation. The authors relate the emotional
feature of burnout to emotional intelligence (Năstasă & Fărcaş, 2015).
Emotional intelligence, a skill that involves perception of personal and individual emotions, also
includes a complex ability to affect interactions with self and others (Ünal, 2014). According to
Tripathy (2018), the evidence of emotional intelligence is the ability to demonstrate personal
competences in self-awareness and self-management and competencies in social skills, namely
social awareness and social relationships. These personal and social competencies of emotional
intelligence involve the cognitive ability to interpret situations, critically analyze, and rationally
address the situation at hand. The prefrontal cortex (the executive function that includes logical
reasoning), and the amygdala, part of the limbic system of the brain specialized in emotions and
memory are involved in this cognitive ability (Savic, 2015).
Healthcare services engage the cognitive skill of the provider and therefore require continual
regulation of their emotions. The development and self-evaluation of emotions is emotional
intelligence (Kabunga, Anyolitho, & Betty, 2020). Kabunga et al. (2020) noted that improving
emotional intelligence led better psychological wellbeing of HCW and hence better workplace
relationships. Emotional intelligence is an individual’s ability to maintain self-efficacy in every
day. This involves being ability to constructively interpret one’s emotions while providing health
services.
The HCW engage in a range of patient clinical presentation and emotions, including death
(Kabunga et al., 2020). HCW who are conscious of their emotional intelligence have adaptive
skills in face of emergencies and judiciously resolve work-related challenges (Ünal, 2014). Ünal
(2014) argues that emotionally intelligent HCW engage in self-awareness ostensibly build
emotional capital with their patients thereby relate better with one another. Subsequently,
communication between them is improved leading to quality care (Năstasă & Fărcaş, 2015).
Emotional intelligence influences efficient conflict management and effectively adjustment to
emotionally charged work-related environment (Năstasă & Fărcaş, 2015). This includes an
individual’s ability to calm themselves influencing others to self-regulate. They also display
management skills and have positive work attitude. Emotional intelligence therefore improves the
individual wellbeing and work performance (Kabunga et al., 2020). In the contrary, lower
emotional intelligence leads to burnout and infective resolution of the effects of burnout.
In a study among Danish physicians, the researchers found an association between alexithymia
(associated with low emotional intelligence), burnout, and alcohol use (Pedersen et al., 2016). Huang et
al., (2019) postulated that emotional intelligence has a positive and protective factor against burnout
and improves mental wellbeing. In Iran, emotional intelligence was found to positively influence lower
perceived stress (Forushani, & Besharat, 2011). South African scholars found that emotional
intelligence helped moderate chronic stress thereby reducing burnout (Görgens‐ Ekermans, & Brand,
2012). Similarly, Kabunga et al. (2020) in Uganda, demonstrated that social competency as an aspect
of emotional intelligence lowered the rate of compassion fatigue. Emotional intelligence requires
effective management of emotional reactions and daily improvement is fundamental (Bradberry &
Greaves, 2009). The implication is that emotional intelligence in a clinical setting can be learned to
alleviate the effects of burnout (Matthews, Zeidner, & Roberts, 2012). In conclusion, there were
positive implications where 1% improvement on aspects of personal emotional intelligence equaled
a 1% reduction in health expenditure (Mikolajczak & Van Bellegem, 2017). These indicators
therefore imply that continued investigation on relationship between burnout and emotional
intelligence is beneficial to the healthcare system, and creates a better experience for patients and
clients.
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