Un estudio sobre la precariedad laboral en enfermería: consecuencias y relaciones en torno al síndrome de agotamiento y el abandono profesional / A study about precarious work in nursing: consequences and relationships around the syndrome of burnout and professional abandonment

Los profesionales de enfermería constituyen cuantitativamente la mayor fuerza de trabajo en los sistemas de salud de casi todos los países del mundo, sin embargo, el índice de abandono de la profesión es importante, un problema que merece encontrar soluciones. Muchos son los motivos que se han esgrimido para ello, pero entre los que menos han sido estudiados, estarían algunas relaciones contractuales precarias que se dan en España y que no parecen estar en sintonía con las recomendaciones internacionales sobre la calidad en el trabajo enfermero. Objetivo: la posible existencia de una relación entre este tipo de contratos con el agotamiento profesional y, en caso positivo, con una posible afectación de la vida cotidiana que redunde en la satisfacción laboral y en la posibilidad del abandono laboral constituye el objetivo principal de este estudio. Método: para ello, se ha llevado a cabo un estudio observacional, descriptivo y transversal sobre una muestra de 216 enfermeros con experiencia en contratos precarios denominados tipo "Pool"/"volante". Los cuestionarios utilizados fueron el Maslach Burnout Inventory, para evaluar el síndrome de agotamiento profesional, y un cuestionario de elaboración propia consistente en 8 preguntas sociodemográficas y sobre aspectos de su vida cotidiana que pudieran tener relación con el abandono laboral. Resultados: la muestra estudiada posee un nivel medio en la escala de agotamiento emocional con 23,3 puntos [desviación típica = 11,42], un nivel elevado en la escala de despersonalización con 10,70 puntos [6,33] y un nivel elevado de realización personal con 31,63 puntos [9,25]. Conclusiones: los resultados de este estudio concluyen que los profesionales con relaciones contractuales "Pool"/"volante" presentan un nivel medio-elevado de agotamiento profesional. A su vez se han podido observar asociaciones estadísticamente significativas entre puntuaciones elevadas en las diferentes esferas del síndrome y aspectos de la vida personal de los enfermeros estudiados, lo que estaría influyendo en los sentimientos de insatisfacción personal y aumentando las posibilidades de incidencia sobre el abandono profesional

Nursing professionals are quantitatively the largest workforce in the health systems of almost all countries in the world however, the rate of abandonment of the profession is important problem that deserves to find solutions. There are many reasons for this, but among those that have been least studied, there would be some precarious contractual relationships that occur in Spain and do not seem to be in line with international recommendations on quality in nursing work. Objective: the possible existence of a relationship between this type of contract with syndrome of burnout and, in a positive case, with a possible impact on daily life, that results in job satisfaction and the possibility of leaving the workplace, is the main objective of this study Method: to this end, an observational, descriptive and cross-sectional study was carried out on a sample of 216 nurses with experience in precarious contracts called "Pool" / "volante", type. The questionnaires used were the Maslach Burnout Inventory, to evaluate the syndrome of professional exhaustion, and a self-prepared questionnaire consisting of 8 sociodemographic questions and aspects of their daily life that may be related to the abandonment of work. Results: the sample studied has an middle level on the emotional exhaustion scale with 23.3 points [standard deviation = 11.42], a high level on the depersonalization scale with 10.70 points[6.33] and a high level of personal achievement with 31.63 points[9.25]. Conclusions: the results of this study conclude that professionals with contractual relations "Pool" / "volante", present a medium-high level of professional exhaustion. At the same time, statistically significant associations have been observed between high scores in the different spheres of the syndrome and aspects of the personal life of the nurses studied, which would be influencing the feelings of personal dissatisfaction and increasing the possibilities of incidence on professional abandonment

Moral Distress (MD) and burnout in mental health nurses: a multicenter survey.

INTRODUCTION: Moral Distress (MD) is a common experience among nurses and if it is not recognised and treated, it may lead to serious consequences on nurses' health and quality of care. MD has been studied in several healthcare contexts. However, there are only few studies on MD in psychiatry and in Italy there are no data in this field.  Objective: To assess the presence of MD among mental health nurses in Italy and verify whether there is a relationship between MD and burnout. METHODS: We conducted a multicentre survey among nurses of Mental Health services of four hospitals in Milan. The MD Scale for Psychiatric NursesItalianrevised (MDS-PItarev) and the Maslach Burnout Inventory (MBI) were used for data collection. Factor analysis and calculation of content validity index (CVI) and Cronbach's alpha were performed on the Italian version of the MDS-PIta. Three items of the old version of the scale were removed, because judged not relevant in the Italian context. The revised scale maintained excellent CVI (0.89) and Cronbach's alpha (0.93). RESULTS: Of 285 questionnaires distributed, 228 (80%) were returned. The median of MD was 2 (scale range 0-6); MD is correlated with two burnout dimensions: emotional exhaustion (rho(ρ)=0.28, p<0,001) and depersonalization (ρ=0.20, p<0,001). CONCLUSIONS: This is the first study about MD among psychiatric nurses in Italy. We found a medium-low level of MD among nurses who participated in the survey. We also found a modest but significant correlation between MD and two dimensions of MBI. Further studies are needed to confirm these results.

Herramientas para hacer frente al Burnout en el personal de enfermería / Tools to face Burnout in nursing: social support, resilence and coping strategies

Objetivos. Establecer las diferencias en apoyo social, resiliencia, estrategias de afrontamiento y las tres dimensiones del burnout (agotamiento emocional, despersonalización y falta de realización personal) entre los profesionales de enfermería de unidades especiales y de hospitalización; determinar las variables psicológicas que predicen el burnout en dichos profesionales. Método. Estudio correlacional de tipo transversal. Participó una muestra de 133 profesionales de enfermería del Hospital Universitario de Fuenlabrada (Madrid), de los cuales 61 pertenecían a servicios especiales y 72 a hospitalización. Instrumentos: Maslach Burnout Inventory-Human Services Survey (MBIHSS), Subescala de Apoyo Social, 10-Item CD-RISC (resiliencia), Brief-Cope (afrontamiento) y variables sociodemográficas. Resultados. No se encontraron diferencias en ninguna de las variables psicológicas evaluadas en función del servicio hospitalario. El apoyo social, la resiliencia y las estrategias de afrontamiento determinaron las tres dimensiones del burnout: el apoyo social (β = -0.21), el afrontamiento de apoyo (β = -0.22) y el de falta de compromiso (β = 0.22) predijeron el agotamiento emocional; la resiliencia (β = -0.22) y el afrontamiento de falta de compromiso (β = 0.30) predijeron la despersonalización; y el afrontamiento de compromiso (β = -0.55) predijo la falta de realización personal. Conclusiones. Las diferencias en apoyo social, resiliencia, estrategias de afrontamiento y burnout no están determinadas por el servicio hospitalario. El apoyo social, la resiliencia y las estrategias de afrontamiento de compromiso y de apoyo (adaptativas) constituyen tres herramientas para hacer frente al burnout en el personal de enfermería. Dichas herramientas se podrían desarrollar mediante programas específicos desde las universidades y las instituciones sanitarias para mejorar la práctica clínica enfermera (AU)

Objectives. To establish the differences in social support, resilience, coping, and three burnout dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment) among special units nursing and nursing staff of others hospital services; as well as to determine psychological variables that predict burnout in these professionals. Method. Correlational and cross-sectorial study. A sample of 133 nursing professionals from University Hospital of Fuenlabrada (Madrid) took part in the study, of whom 61 worked in special units and 72 in wards. Instruments: Maslach Burnout Inventory- Human Services Survey (MBI-HSS), Social Support Subscale, 10- Item CD-RISC (resilience), Brief-Cope (coping), and sociodemographic variables. Results. No differences were found in any assessed psychological variables as regards hospital service worked in. Social support, resilience and coping strategies determined three burnout dimensions: social support (β = -0.21), support coping (β = -0.22) and disengagement coping (β = 0.22) predicted emotional exhaustion; resilience (β = -0.22) and disengagement coping (β = 0.30) predicted depersonalization; and engagement coping (β = -0.55) predicted reduce personal accomplishment. Conclusions. Differences in burnout, social support, resilience and coping strategies are not determined by hospital service. Social support, resilience, engagement coping, and support coping (adaptives) constitute three tools to face burnout in nursing. These tools could be developed by specific programs from universities and health institutions to improve nursing clinical practice (AU)

Factores de riesgo y niveles de burnout en enfermeras de atención primaria: una revisión sistemática / Risk factors and burnout levels in Primary Care nurses: a systematic review

OBJETIVO: Conocer los factores de riesgo y los niveles de burnout en enfermeras de :atención primaria. METODOLOGÍA: Se realizó una revisión sistemática. Fuentes de datos. Se consultaron CINAHL, CUIDEN, LILACS, Pubmed, ProQuest, ScienceDirect y Scopus. Las ecuaciones de búsqueda fueron: «burnout AND community health nursing» y «burnout AND primary care nursing». La búsqueda se realizó en octubre del 2015. Selección de estudios. La muestra final fue de n=12. Se incluyeron estudios primarios cuantitativos que utilizasen el Maslach Burnout Inventory para evaluar el burnout en enfermeras de atención primaria, sin restricción por fecha de publicación. Extracción de datos. Las principales variables fueron la media y desviación típica de las 3 dimensiones del burnout, las prevalencias de niveles bajos, medios y altos de cada dimensión, y los factores sociodemográficos, laborales y psicológicos que potencialmente influyen en su desarrollo. RESULTADOS: Los estudios muestran prevalencias de cansancio emocional alto, por lo general, entre el 23 y el 31%. Las prevalencias de despersonalización alta y realización personal baja muestran heterogeneidad, variando entre el 8-32 y el 4-92% de la muestra respectivamente. Los estudios informan de que las enfermeras con mayor edad, mayor antigüedad laboral, ansiedad y depresión, entre otras variables, presentan mayores niveles de burnout, mientras que aquellas con mayor sueldo, satisfacción laboral alta, apoyo de la organización y buen autoconcepto lo padecen menos. CONCLUSIÓN: El cansancio emocional alto es la principal dimensión del burnout afectada en la enfermería de atención primaria. En despersonalización y realización personal existe heterogeneidad. Debe prevenirse el burnout en estos profesionales potenciando los factores protectores y vigilando su aparición en los que presenten factores de riesgo

OBJECTIVE: To determine the risk factors and levels of burnout in Primary Care nurses. METHODS: A systematic review was performed. Data sources. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. Study selection. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. Data extraction. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. RESULTS: Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. CONCLUSION: High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors

[Burnout symptoms in Austrian student nurses in their third year of training]. / Burnout-Symptome bei österreichischen PflegeschülerInnen im dritten Ausbildungsjahr.

Burnout is considered a major negative outcome of work related distress in social and health care services, especially in nursing. In the present study 179 student nurses in their third year of training and 47 registered nurses, all working in the Austrian province of Salzburg, were examined with the Maslach Burnout Inventory and the Satisfaction With Life Scale. Compared on a regional and national level, burnout scores of student nurses were equal to those of registered nurses and workers in social and nursing professions. The specific stressors of education and training lead to strain comparable to years of professional experience and exposure to stressors. The relatively high level of satisfaction with life in student nurses may be due to specific resources and ways of compensation, that require further examination. Differences between urban and rural districts (with lower burnout scores and higher satisfaction with life sores in rural districts) were strong in student nurses. Compared with international nurse and health care samples, burnout is relatively low in the examined groups. Registered nurses and student nurses in rural districts show the lowest scores of all in emotional exhaustion and depersonalization, respectively.

Burnout among nursing staff in accident and emergency and acute medicine: a comparative study.

This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting. A triangulated research design was used incorporating quantitative and qualitative methods. Maslach Burnout Inventory was used. Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff. Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.

The impact of technology on patients and families.

The continuing evolution of the highly specialized, technologic manner in which we provide care in critical care units has potentially hazardous effects on the physical and psychological well-being of patients and family members. Although the ICU environment possesses characteristics that make patients and families prone to undesirable sequelae, critical care nurses can employ creative strategies to minimize the impact of bedside technology that is so important for the survival and recovery of the critically ill patient. Strategies to reduce the psychological impact of the ICU environment begin with a psychosocial assessment of the meaning patients and families attach to bedside technology. This assessment will strengthen nurse, patient, and family interactions, as well as guide patient and family education and sensory information to reduce fear and anxiety often associated with threatening procedures. Facilitating touch and family involvement in the patient's care during visitation is another strategy to humanize the technologic environment. Managing the environment is essential to reduce the physical impact of the ICU environment. Nurses can manipulate the use of equipment to reduce crowding and noise at the bedside, foster familiar activities to stimulate the patient's other senses, and facilitate sleep patterns by structuring nursing activities and providing comfort measures. These nursing interventions will reduce the effects of sensory overload/deprivation and sleep deprivation and, it is hoped, prevent ICU psychosis.