Abstract
Approximately fifteen million babies in the world are born each year prematurely; out of that number, 1.1 million eventually die. Neonatal Intensive Care Unit (NICU) nurses provide vital care for these vulnerable babies and their families. These nurses encounter numerous challenges while providing care services such as a loss of energy, loss of enthusiasm, and lack of accomplishment, which are the dimensions of burnout.
Purpose: Conduct a meta-analysis to determine the factors related to burnout and identify the subsequent implications for practice.
Design: A meta-analysis was conducted for the existing literature regarding burnout in NICU. This consisted of XX relevant articles within the last five years.
Results: The primary indicators of burnout were XXXX. Possible interventions to reduce or prevent burnout in this population will be explored.
Burnout among Neonatal Intensive Care Unit Nurses: Systematic Review of Influencing Factors
Introduction
Human capabilities require much consideration before setting targets. Nurses have exhaust points, since they are entirely human. The intensive care unit is delicate and demands maximum attention of a professional. Nurses have most charge of the patients. In the case where the patient is a prematurely born infant, the risk of losing life is higher, since they remain in the intensive care nurseries until they are strong enough to cope with the new environment. The underdeveloped being, therefore, need more focus and analytical professionalism from the nurses in charge. The most common result of exhausted professionals is low-quality output and divided attention. The current state of intensive care unit technology require analytical observation, and the moment changes occur the professional should be in the right state of mind to ensure the right course of action for instance call a doctor or change medication. The infants in nurseries have the technology to thank, but the nurses assist in observing and ensuring their wellbeing. Clear minds are, therefore, highly recommended. The point where nurses cannot produce quality output due to mental collapse while dealing with the intensive care unit of prematurely born infants is termed as burnout among neonatal intensive care unit nurses.
However, there have been claims of increased debate about the inability of contemporary nurses to provide adequate neonatal care services to infants. Burnout among nurses has been identified as one of the major impediments to the quality of neonatal care offered to infants in the intensive care unit (ICU). This paper discusses the impact of burnout among neonatal intensive care unit (NICU) nurses on the provision of infant care services.
Literature Review
Herbert Freudenberger, a psychiatrist, introduced the term “burnout” in 1974 after studying volunteers with substance abuse homeless people at St. Mark’s Free Clinic. Initially, these volunteers were passionately engaged in their social occupation but finally experienced emotional and physical exhaustion while performing their duties. Freudenberger used the term “burnout” to place a label on the phenomenon that he personally experienced and witnessed a state of exhaustion with a loss of idealism because of being overworked while caring for those suffering from the devastating effects of chronic substance abuse (Schaufeli, 1999). Often in the literature, a fire-related metaphor is used symbolically to explain the phenomenon of burnout. The fire represents the individual; if the fuel for one’s task is not replenished, then he or she eventually faces exhaustion from being overworked and the failure to find meaning to his or her contributions (Schaufeli, 1999).
Freudenberger’s initial observation on burnout leads to the empirical research that Maslach et al. conducted in the late 1970s. Maslach, a social psychologist, studied the way in which “workers coped with their emotional arousal using cognitive strategies such as detached concern” (Schaufeli, Leiter, & Maslach, 2009, p. 205). Maslach learned workers often felt emotionally exhausted and developed negative feelings toward their clients. They eventually experienced crises in professional competence because of their feelings (Maslach, Leiter, & Maslach, 2009). Maslach and Jackson (1981) developed the conceptualization of the term burnout that would be used for years to come. They described burnout as a syndrome of emotional exhaustion and cynicism in response to the exposure of prolonged, chronic, stressful work environments. Maslach, Schaufeli, & Leiter (2001) developed a burnout instrument entitled the Maslach Burnout Inventory (MBI) to measure emotional exhaustion, depersonalization, and reduced professional efficacy. Academicians and researchers in the literature in the United States have used MBI extensively.
The three dimensions of exhaustion, depersonalization, and inefficacy (Maslach et al., 2001, p. 402) define burnout. There are three psychological factors that cause long stress hours at work environments, namely: (1) feelings of emotional exhaustion;(2) negative attitudes and emotions towards those who are beneficiaries of the service (depersonalization); and (3)sentiments of lack accomplishment or personal inefficacy (Maslach & Schaufeli, 1993).Individuals in a care-giving role experience affective, behavioral, cognitive, emotional, motivational, physical, and psychosomatic symptoms from burnout that often affect their delivery of health care to patients that they were once motivated to serve. Studies show that nurses who work under influence of physical, mental and emotional pressure tend to act unprofessionally. The unprofessional treatment of patients includes little focus with the right medication, inaccurate doses and inconsiderate treatment of the patients. In the intensive care unit, the patient is not in positions of confirming their treatment. Doses and types of medication is very sensitive with infants prematurely born (Maslach & Schaufeli, 1993).
Cordes and Dougherty (1993) elaborated on the dimensions of burnout. Emotional exhaustion occurs when health professionals feel that their emotional resources and control are depleted. They feel that they are currently less capable of rendering quality health care services than in the past (Cordes & Dougherty, 1993, p. 623). In cognitive and emotional terms, burnout health professional experience symptoms of increased tension and frustration that leads to the inability to concentrate, forgetfulness, difficulty with complex tasks and in making decisions. An additional symptom of burnout is the sense of dread when returning to work the following day (Cordes & Dougherty, 1993).
The depersonalization dimension of burnout is characterized by a health professional who becomes cynical, dehumanizes patients, treats them as objects instead of individuals, and uses abstract language to describe them (Cordes & Dougherty, 1993). Depersonalization may cause a health professional to have a hostile, callous attitude, and become cynical (Cordes & Dougherty, 1993). Other visible symptoms include the stringent compartmentalization of their working lives, overly intellectualizing the condition of a patient, less work time, extensive use of health-related terminology, and lengthy conversations with workmates (Cordes & Dougherty, 1993, p. 623).
The third dimension of burnout known as personal inefficacy is marked by a psychological tendency to assess oneself (Cordes & Dougherty, 1993) negatively. Cordes & Dougherty (1993, pp. 623-624) explained that individuals occupying high-stress occupations such as health-care service provision experience a sense of inadequacy as it pertains to competence levels and creation of good work relationships with other people. Often, a person who experiences this dimension of burnout feels as though he or she lacks professional progression (Cordes & Dougherty 1993).
Development of Burnout
Burnout develops over time and is defined as an extended work-related reaction to chronic emotional and interpersonal stressors (Maslach et al., 2001). Although Maslach et al. (2001) attribute burnout to the nature of the job, current studies suggest that burnout may also develop from other areas of an individual’s life (Bianchi, Truchot, Laurent, Brisson, & Schonfeld, 2014). Burnout progresses through stages. A job may require excess resources, which leads to exhaustion. Next, cynicism sets in and fosters withdrawal and disengagement. Last, individuals feel a sense of distance and lack of effectiveness with a loss of professional competence (Cordes & Dougherty, 1993).
Burnout versus Stress
The topic of stress in relation to nursing has been researched extensively. Nurses are prone to stress as an occupational hazard; an environment that is emotionally challenging and demanding (Maslach et al., 2012), creates it. In general, everyday stressors happen and individuals adjust and adapt to the resultant stress. Burnout is considered that eventually may lead to exhaustion, cynicism, and a lack of professional efficacy (Maslach, et al., 2012).
Burnout versus Compassion Fatigue
Alternatively, burnout is referred to as “compassion fatigue,” also termed “vicarious traumatization” (Cordes & Dougherty, 1993, p. 623; Lambardo & Eyre, 2011, para. 5). Lambardo and Eyre mentioned that Joinson, a nurse who recognized that compassion fatigue is a “unique form of burnout that affects individuals in care giving roles”, first defined compassion fatigue (Lambardo & Eyre, 2011).Compassion fatigue is the cumulative effect of caring for and being associated with patients who suffer significant pain and distress (Lambardo & Eyre, 2011). Burnout is the process of emotional exhaustion and withdrawal that is associated with increased workload and institutional stress, but is not found to be related to trauma (Lambardo & Eyre, 2011).
Burnout versus Depression
Burnout and depression share all of the same symptoms and are difficult to separate. Depression is a pervasive disorder that affects all aspects of an individual’s life and prevents him or her from enjoying once pleasurable activities. Burnout is time limited to the hours spent on the job and relates to the ability to enjoy non-work activities (Cordes, & Dougherty, 1993).
Burnout in the Neonatal Intensive Care Unit (NICU) Nurse
Burnout among Neonatal Intensive Care Unit (NICU) nurses is a major issue. Braithwaite (2008) assets that NICU nurses experience high levels of physical and psychological stress due to the work environment. Burnout develops when nurses do not find meaning to their work (Braithwaite, 2008). Braithwaite (2008) added that thestress can generate energy and urgency, but burnout causes hopelessness and helplessness. The dimensions of burnout are emotional exhaustion, depersonalization, and a reduction in the sense of personal accomplishment. It negative impact on nurses, patients, and the organization in general. It causes health problems including hypertension, cardiovascular diseases, gastrointestinal diseases, and increased risk of another disease. Furthermore, it is linked with mental issues such as feelings of guilt, anxiety, anger, shame, anti-social behavior, and sometimes depression. This may result in compulsive behaviors, including alcohol and drug abuse (Braithwaite, 2008)
Burnout has a major effect on hospital financial health. The cost of employee turnover can reach almost 150% of a worker’s compensation in a year. Burnout also leads to absenteeism, and regular and long-term sick leaves (Braithwaite, 2008).
Burnout also reduces patient satisfaction as nurses form a negative attitude toward patients and families. They find it challenging to empathize with patients and offer quality care to both their patients and their families. Burnout also harms personal and professional relationships (Braithwaite, 2008).
In addition, burnout compromises patient safety. The physical and emotional symptoms take a toll on the nurse and make it difficult to recognize or report medical errors or to follow-up on incident reports (Braithwaite, 2008).
Different personal and interpersonal factors contribute to burnout among nurses, such as age, experience, job status, and resiliency. The nurses with a hardy personality can cope with stress by taking control over situations in life and maintaining optimism. They can deal with change and take care of themselves. Nurses who are unable to separate work and personal life experience burnout (Braithwaite, 2008).
Stressors in the work environment, like noise, constant changing of patients and technology and care practices can regularly cause stress. They affect nurse performance, decrease retention, and increase medical errors (Braithwaite, 2008).
Birth of premature or ill infants may cause ethical dilemmas, which can result in conflict with personal values when the nurse believes certain practices to be unethical. In many instances, nurses are required to perform actions that conflict with their personal values (Braithwaite, 2008).
Methodologies Used in Measuring the Impact of Burnout
BI is a valid and reliable instrument for measuring burnout. The MBI measures the three dimensions of burnout: emotional exhaustion, depersonalization, and personal inefficacy (Maslach, Schaufeli, & Leiter, 2001). The first dimension of burnout (exhaustion) measures feelings of being emotionally strained and exhausted by another person’s work. If an individual scores high in this dimension, it reveals distress and burnout. The second dimension, depersonalization, measures one’s cynicism, the impersonal response towards beneficiary of one’s service; high score indicates burnout. The third dimension of burnout, which is personalinefficacy measures personal levels of competence and attainment as indicated by a score for burnout (Maslach et al., 2012).
Recent research studies such as those conducted by Sexton and colleagues in 2014, used the MBI to assess the impact of burnout on nurses working in 44 neonatal intensive care units (NICUs) in the state of California. The researchers confirmed that this inventory was reliable and valid measurement for burnout (Sexton et al., p. 816). Additionally, Poghosyan, Aiken, and Sloane (2009) contended that the three-dimensional structure of the MBI was largely validated when used to assess nurses from eight countries: the United States, Canada, the United Kingdom, Germany, New Zealand, Russia, Armenia, and Japan.
Literature Search Method
The search consisted only of articles written in English between 1984 and 2014, and performed using electronic library databases (e.g., CINAHL, PubMed, Scopus and Web of Science). The search involved keywords of possible combinations of “burnout” with “Neonatal Intensive Care Nurses.” Articles that were included in this systematic review fulfilled the following criteria: (a) focused only on the topic of burnout in the NICU in the last five years; (b) majority of the studies were conducted in the United Sates. (c) No review articles were included in the final systematic review. XX articles were quantitative studiesXX qualitative studies.
