Correlation between Burnout and Role of Patient Advocacy in ICU Nurses

Mohadeseh Motamed-Jahromi, Abbas Abbaszadeh, Tayebeh Jalali



Background and Aim: Nurses suffer from burnout due to frequent and daily exposure to stressful situations more than those in other occupations. Nurses in ICUs are more exposed to burnout compared to the nurses of other parts due to exposure to various stresses such as high pressure, decision making in urgent situations and responsiveness to the results of each decision, permanent attempt to prevent mistakes, especially exposure to death and disability of patients. For this reason, job burnout in nurses working in ICUs is more than other nurses and can affect the role of nursing professionals, especially patient advocacy. The aim of this study was to determine the correlation between attitude towards the role of patient advocacy and job burnout among nurses in ICUs.

Materials and Methods: This descriptive-analytic study was conducted on nurses working in three educational hospitals affiliated to Kerman University of Medical Sciences in 2013. Of the 250 nurses working in adult and child ICUs (ICU, NICU, CCU, dialysis), 183 subjects who had inclusion criteria were selected using the available method. The criteria for entering the study include having at least undergraduate degree in nursing, a 6-month work history in clinical settings, and full-time clinical work. A three-part demographic questionnaire, "Maslach Burnout Inventory", and a nurses' attitude survey questionnaire on the role of patient advocacy were used to collect the data. The first part examines demographic characteristics, including age, gender, marital status, education level, employment area and years of work experience. The second part is a 22-item questionnaire that covers all three areas of occupational burnout; nine items are related to the emotional exhaustion of nurses against the clients and the workplace; five items are related to depersonalization (nurses' disinterest and indifference to clients); and eight items are related to the lack of individual's success that helps the nurse to express the degree of satisfaction and achievement of success in patient care. The frequency of questionnaire items is from zero to six as never, several times a year, once a month, several times a month, once a week, several times a week, and every day. The Persian translation of the Maslach Burnout Inventory has been reviewed by Akbari et al (2011) and has been approved by three English language instructors in terms of accuracy of translation and compliance with its English Principles. In this study, the validity of this questionnaire was evaluated by 10 faculty members, and the CVI was calculated as 88%. Cronbach's alpha was calculated as 0.89 with a sample size of 30. The third part, the 19-item questionnaire, was selected from the questionnaires used in the Barrett-Sheridan and Hanks study, which evaluates nurses' attitude towards the role of patient advocacy. Two-way translation of English to Farsi and vice versa, and validity and reliability, and factor analysis of this questionnaire were done by Motamed et al. (2012) and CVI is estimated as 86% and Cronbach's alpha is 0.77. All items of the present questionnaire are ranked using the 5-point Likert scale. Attitudinal questions were divided into two subscales of the cognitive aspect (10 items) and the behavioral aspect (9 items) (5). For data analysis, descriptive statistics and inferential tests (Pearson correlation coefficient, independent t-test and one-way ANOVA) were used in SPSS 18 software.

Ethical considerations: After acquisition of the code of ethics committee approval of number K / 93/30 from the Vice-Chancellor for Research, Kerman University of Medical Sciences and obtaining other necessary permits, and explaining the objectives of the research, the informed consent of the participants was obtained and it was assured about the confidentiality of information. The response rate to the questionnaires was 96.3% (183 out of 190 questionnaires). The median age of participants was 35 ± 1/34 years in the range of 22 to 48 years old.

Findings: The majority of them were female (90.3%) and had undergraduate education (9.1%). More than half of the nurses had a work experience of between 6 months and 10 years. In terms of type of division, the majority of participants were engaged in adult ICUs. The average burnout rate of participants was 4.02 ± 0.26 and the mean of attitude towards the role of patient advocacy was 3.72 ± 0.50. There was a significant negative relationship between attitude towards the role of patient advocacy and job burnout (r = -0.07, p = 0.035). There was a significant negative relationship between cognitive factors of attitude towards the role of patient advocacy with dimensions of emotional exhaustion (r = -0.81, p = 0.03) and lack of personal success and burnout (r = -0.12, p=0.04). But this relationship was not meaningful with the dimension of burnout. (r=0.10, p=0.15). Also, there was a significant negative relationship between attitudinal behavioral factor towards the role of patient advocacy with the dimension of the lack of personal success and burnout (r = -0.21, p = 0.03). But this relationship was not significant with the dimensions of emotional exhaustion and depersonalization of burnout (r = 0.03, p = 0.65). There was no statistically significant correlation between mean of burnout and demographic characteristics of participants (p = 0.86). But there was a significant statistical relationship between the mean attitude towards the role of patient advocacy and education level of the participants (p = 0.04).

Conclusion: Regarding the existence of a significant negative correlation between attitude towards the role of patient advocacy and job burnout among nurses working in ICUs, providing the necessary conditions to support patients causes the improvement of nurses' attitudes towards patient advocacy, competence and their efficiency and thus reduces their burnout. Also, considering the significant relationship between the attitude towards the role of patient advocacy and the education level of the participants, it is suggested to include training the role of patient advocacy, the ability to identify patient advocacy situations, how they are correctly expressed to others and manage it, in the nursing program so as to help nurses become professional and increase their efficiency and competency which will ultimately increase job satisfaction and reduce burnout. Among the limitations of this study are available sampling and the absolute use of a questionnaire to measure variables. In order to generalize the findings, the study is proposed in both quantitative and qualitative methods in a wider geographical range with larger sample size.

Please cite this article as: Motamed-Jahromi M, Abbaszadeh A, Jalali T. Correlation between Burnout and Role of Patient Advocacy in ICU Nurses. Med Ethics J 2017; 11(40): 29-37.


Burnout; Patient Advocacy; Nurses; ICUs

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