Relationship of Burnout and Perception of Family Functioning

of Level III Student Nurses of UERMMMCI

A Research Study Presented to the Faculty of Instruction of the

University of the East Ramon Magsaysay Memorial Medical Center
College of Nursing

In Partial Fulfillment of the Requirements in Nursing Research II

By:

De los Reyes, Diane

Delos Santos, Romaine Marie

Demeterio, Joy

Diego, Jun Albert

Silao, Joanna Mae Christine

Taberna, Mark Louis

Tan, Abegail

Vejano, Carlo Angelo

N3C

CHAPTER 1
Introduction

In the study conducted by Muyibi, Ajayi, Irabor&Ladipo (2010) about Relationship between

Adolescents’ Family Function with Socio-demographic Characteristics and Behavior Risk

Factors in a Primary Care Facility,ofthe adolescents in the study, 338 (84.5%) were part of a

functional family, sixty subjects (15%) belonged to moderately dysfunctional family, while two

subjects (0.5%) were from severely dysfunctional family. The majority of the adolescents were

rated as having functional families. The social characteristics of the respondents studied showed

that there was a significant association between perceived family function and subjects’ gender.

Being a nursing student, it requires an intense period of time. It does not only require

long periods of hours spent in classroom lectures and clinical duty but also the extra time

students spend for individual and group works to accomplish requirements which are already

considered outside the official schedule.

Most of the schedule of nursing students composes classroom lectures for 3-8 hours and

clinical duty of 4-8 hours. In addition to this, some students also require a number of hours of

transportation to and from school. Also, they need to spend time beyond their official schedule

for accomplishment of home works, group works, other requirements and reviewing their lessons

for their exam. Because of these, student nurses are high risk to experience burnout.

According to Elizabeth Hall (2004) on her study about Nurse Burnout in a high stress

Health Care Environment: Prognosis Better than Expected?,Burnout is frequently studied in

populations of nurses for several reasons. These reasons include the fact that nursing is a large
health care professional body, it has been linked to a high incidence of burnout (Jones, 1962), the

very nature of nursing is based on empathy, compassion and humanisation of medicine, and

nurses as professionals are involved with people on an extremely personal level in an

environment that is not always conducive to positive consequences (Buunk et al., 2001a).”

Because of experiencing burnout by the student nurses, it will cause less time will be

spend with familyalso affect their family functioning.

Most studies regarding burnout focused on teacher burnout and burnout in job or work.

Other researches also tackle student burnouts, but these researches do not show the direct

relationship between burnout and perceived family functioning.

It was defined that burnout is “a psychological syndrome of emotional exhaustion,

depersonalization, and reduced personal accomplishment that can occur among individuals who

work with other people in some capacity” ( Maslach& Jackson, 1986, p.1). This definition

focuses only on burnout of people having occupations regarding human service professions such

as physicians. On the other hand, one study suggests that the phenomenon and process of

burnout is the samewhether occupations are within or outside human service professions

(Demerouti& Bakker, 2007). Another definition which pertains to burnout of people having

professions not related to human service is based on three dimensions: emotional exhaustion,

cynicism, and professional efficacy (Rostami, Abedin&Schaufeli, 2012).

 According to the family systems approach, the family is an interactional system whose

component parts have constantly shifting boundaries and varying degrees of resistance to change

(Allen, 2007). The concept of family functioning consists of the quality of relationship between

the members of the family and the information, which reflects the contribution of family

members to life quality (Bulut, 1989). Through the successful performance of the functions of

family as a system, family members can have opportunities for increasing their satisfaction of

life, sense of responsibility, self-confidence, happiness, and productivity. Family functioning is

classified as biological, social, psychological, and economic (Bulut, 1989; Gander & Gardiner,

1995).

The definition of family in the context of Family Apgar, is that it is a psychosocial group

which consists of the patient and one or more persons, children or adults. There is a commitment

for members to nurture each other,(Shortridge-Bagget,Malmgreen&Wantroba, 2004).

The purpose of this study is to determine the relationship of burnout being experienced

by student nurses and their perception of family functioning. Being able to do this, student nurses

can be aware and then find ways to handle burnout if it can be proved in this study that it affects

family functioning which is one essential factor in construction of one’s personality. It has a

primary effect on an individual’s life in terms of his/her adaptation to the society where he/she

lives in.

Research Questions:

1. What is the respondent’s level of:

a. Burnout;
 b. Perception of family function?

2. What is the relationship between burnout and perception of family functioning of level III

student nurses of UERMMMCI?

Hypothesis

1. There is a relationship between burnout and perception of family functioning of level III

student nurses of UERMMMCI.

2. There is no relationship between burnout and perception of family functioning of level III

student nurses of UERMMMCI.

Scope and Delimitation

The scope of the study consists of regularly enrolled Level III student nurses of

UERMMMCI College of Nursing. A sample size was determined by use of simple random

sampling. Questionnaires would be given only within the UERMMMCI campus to the randomly

selected respondents. The study was limited to Level III student nurses since this would be one

way to, although not totally, control the extraneous variable difference in school load between

different year levels that could affect the relationship. Also, irregular students were not included

since they have a different school loads. Limitations would as well include other extraneous

variables which cannot be controlled by the investigators. The extraneous variables considered

to be beyond the control of the investigators would be as follows: age, gender, existing problem,

religion, economic status, and social support.

Conceptual Framework

Burnout Family Functioning Outcomes:

- highly functional

-moderately dysfunctional

-severely dysfunctional

Extraneous Variables

 age
 gender
 existing problem/s
 religion
 economic status
 social support

Operational definition of terms:

Burnout- measured by use of three dimensions namely emotional exhaustion, cynicism, and

professional efficacy

Family functioning- its measure consists of five parameters namely adaptability, partnership,

growth, affection and resolve

Highly functional- a score of 8-10 on family APGAR assessment tool

Moderately dysfunctional- a score of 4-7 on family APGAR assessment tool

Severely dysfunctional- a score 0-3 on family APGAR assessment tool

Age- the length of time a person has existed

Gender- thebehavioral, cultural, or psychological traits typically associated with one sex

Existing problem- problem that the student is currently experiencing

Religion- a personal set or institutionalized system of religious attitudes, beliefs, and practices

Economic status- family’s monthly income

Existing problem- problem that the student is currently experiencing

Social support-group of people or an individual who provided support

 CHAPTER 2

Review of Related Literature

Burnout

According to the study of Mazerolle and Pagnotta (2011) on Perceptions of Burnout from

the Students’ Perspective, “the terms stress and burnout are often used interchangeably; however,

the two are different, and are often differentiated by physical versus emotional exhaustion, as

well as duration of those stressors. Stress is the body’s response to a stimulus, but is often a

result of an individual being overwhelmed by multiple roles, demands, and responsibilities. A

person who is experiencing stress is still able to manage his or her responsibilities. Burnout is

more characterized by a lack of interest and motivation for once enjoyable tasks. Often burnout

causes a void of feelings, emotions, and abilities to perform once easy tasks.” Their study also

discussed the coping strategies used to manage burnout such as social support and personal time.

They defined social support as groups of people or an individual who provided support and

shared other or outside interests, who ultimately helped the student, reduce stressful experiences.

Personal time is simply characterized the participant’s utilization of free time to rejuvenate or

cope with the stress in their lives. The limitations of their study are that they utilized a web-based

management system to facilitate and collect data. Although a viable data collection tool, they did

not conduct follow-up phone interviews to clarify or confirm responses to the questions posted

on-line. Steps, including a pilot study, however, were taken to reduce the chance for

misinterpretation of the questions posted.

According to the well-known definition of burn-out (Maslach, 1976; Maslach and

Jackson, 1981), burned-out people suffer from emotional exhaustion,depersonalization, and a

reduced sense of personal accomplishment. Emotional exhaustion refers to feelings of being

emotionally overextended and having depleted one’s emotional resources. Depersonalization

refers to a negative, callous, and detached attitude towards the people one works with, i.e.

patients, clients, or students. Reduced personal accomplishment refers to someone’s negative

self-evaluation in relation to his job performance (Schaufeli et al., 1993)

Many studies of burn-out stress a behavioral aspect of the syndrome while many others

stress a mental aspect. Oranje (2001) divides studies on burnout into three categories. First, burn-

out is considered to be a coping problem (the interaction model), i.e. burn-out stems from the

negative outcome of an individual’s judgment of his own abilities in relation to real or imagined

stressors in the individual’s environment (Byrne, 1991; Cherniss, 1980; Eskridge and Coker,

1985). Second, some studies view burnout as a state of both physical and mental exhaustion that

strikes the individuals involved for a long time in situations that exact a heavy emotional toll

(Kremer-Hayon and Kurtz, 1985). This view is categorized as the response or physiological

model. Third, the basic principle of some studies is the view that it is the environment that

produces stressors responsible for the onset of burn-out. Examples of such environmental

stressors are the social relationships of the teachers with students, colleagues and principals

(Brouwers and Tomic, 1999; Feitler and Tokar, 1980) and the organizational working

circumstances (Brenner et al., 1985; Burke and Richardsen, 1996; Van Dierendonck et al., 1998).

On the study of Karabiyik, Eker, and Anbar on Determining the Factors that Affect

Burnout among Academicians, they measured the levels of burnout among academicians and

they investigated the factors that affected burnout levels among academicians in Turkey. The
results of their study revealed five factors which have possible effect on burnout among

academicians. Those are: work environment, administrative workload, academic workload,

promotion and evaluation and research fund. Also they mentioned that:

“Burnout has an importance in business and social life because of its effects.
Firstly, burnout has negative impacts on the psychological and physical health of
individuals. Burnout is a putative factor in the development of family discord,
drug and alcohol abuse, insomnia, and fatigue (Evers/Tomic, 2003: 329;
Mcdonald/Siegall, 1998: ; Bailey, 2006: 11; Jackson/Maslach, 1982: 63).”

On the Study of Yip, Rowlinson, Kvan and Lingard (2005) about Burnout among Future

Construction Professionals in Hong Kong, they indicated the contributing factors of student

burnout:

“Previous research (Cordes and Dougherty 1993) showed that,

individualsexperiencingstress, resulting in long periods of chronic burnout, are
associated with physical healthproblems such as depression and sleep disturbance.
This is supported by SchaufeliandEnzmann (1998) that burnout is contributed by
long hours, subjective overload andthe requirement to fulfil the demands of
conflicting roles.”

They also associated burnout with certain stressors such as long hours of spent

studying,academic performance, uncertainty about the future, difficulty in maintaining

relationships, not having enough time, having little control and interaction with peers(Boudreau

et al. 2004).Burnout was associated with low levels of supportfrom friends and decreased

satisfaction with the respondent’s balance betweenpersonal and professional life.

Some study also provided information about the student’s burnout. On the study of

Adonis P. David (2010) about Examining the relationship of personality and burnout in college

students: The role of academic motivation, also supported the information about student’s

burnout.In this study, it was stated that Burnout has originally been conceived as a work-related
syndrome experienced by individuals who work in human services domain like health care and

social work (Maslach& Jackson, 1981). More recently, it has been shown that burnout is also

experienced by school students (e.g., Gan, Shang, & Zhang, 2007; Salmela-Aro, Kiuru,

Leskinen, &Nurmi, 2009; Schaufeli, Martinez, Marquez-Pinto, Salanova, & Bakker, 2002). The

concept of burnout has been extended to school context because the primary activities of students

like attending classes, reviewing lessons, and making assignments can be considered as work.

However, although there has been an upward trend in the study of burnout in the school context,

much is still to be known about burnout in students. For instance, the extent to which personality

relates to student burnout has yet to be fully established and much of the literature on this

relationship has been on job burnout. And in David, A. P. 91 Educational Measurement and

Evaluation Review (EMEReview), July 2010 spite of the academic nature of the work of

students in school, little has been said on the role of academic motivation in student burnout.

College students face many challenges in their pursuit of higher education. The

continuing demands of schoolwork and presence of stressors may lead to negative outcomes like

burnout.

In the study, Dose interest predicts academic burnout?ofZeinabRostamiet,al.

(2011)states that:

“According to Jacobs & Dodd,2003; Schaufeli, et al.,2002 burnout is a problem

affecting many college and university students and in this case of students,
burnout refer to feelings of exhaustion dueto study demands, cynical attitudes
toward one's studies, and feelings of ineptness as a student.”
 However, it is now recognized that, although students are not formally employed by

theuniversity, their studies encompass structured and often coercive activities (e.g., attending

class and submitting assignments) that can be considered work (Hu et al., 2009).Lingard(2007)

was reported that university students are a high risk group for burnout. Further,Boudreau et al.

(2004) found that burnout was assessed with numerous stressors, includinglong hours engaged in

practicum work, concern about academic grades, uncertainly about the future, low levels of

control, lees satisfaction with the balance between personal andprofessional life and low levels of

support from peers and friends.

Burnout was also experienced specifically by the Student Nurses and it was supported by

some of the studies. According to Watson, R. et. al. (2008) in his study, A study of stress and

burnout in nursing students in Hong Kong: A questionnaire survey,also included a statement

that:

“Nursing students not only experience such stress in Clinical practice but also
from sources such as separation from home, financial worries, regular clinical and
educational assessment and frequently changing clinical environments (Deary et
al., 2003). Deary et al. (2003) showed that nursing students experience increasing
levels of stress and psychological morbidity throughout their nursing programme
and that the personality trait of neuroticism was initially associated with the
emotional exhaustion aspect of burnout and that conscientiousness was associated
with a greater sense of achievement from work.”

Nursing students encounter an array of new and sometimes difficult circumstances when

they enter their programme of education and this provides the stimulus for stress. These nursing

students will all be individuals taking into their programmes a range of personality types and

coping strategies providing responses to stressful situations; therefore, the interaction between

their circumstances and their responses is of interest. In the case of nursing students, the kind of
stress resulting from this transaction between stimuli and responses is classified as occupational

or work related stress (Jones & Johnson, 2000).

On the Study of Elizabeth Hall (2004) about Nurse Burnout in a high stress Health Care

Environment: Prognosis Better than Expected?,she was stated that:

“Burnout is frequently studied in populations of nurses for several reasons. These

reasons include the fact that nursing is a large health care professional body, it has
been linked to a high incidence of burnout (Jones, 1962), the very nature of
nursing is based on empathy, compassion and humanisation of medicine, and
nurses as professionals are involved with people on an extremely personal level in
an environment that is not always conducive to positive consequences (Buunk et
al., 2001a).”

Nursing is characterized by exposure to a wide range of potentially stressful situations

and conditions (Buchan, 1995; Collins, 2000; McAbee, 1991; Santamaria, 1996). Job stressors

include factors such as excessive or high workloads (Kelly & Cross, 1985; Motowidlo, Packard,

& Manning, 1986), irregular and unsocial hours of work (Kandolin, 1993), physical tiredness

(Power & Sharp, 1988), the emotional demands of dealing with sick patients and their families

and with patients whose behaviours are difficult (Podrasky& Sexton, 1988), and lack of staff

support, uncertainty concerning treatment, conflict with other nurses, supervisors and medical

staff, dealing with death and dying, management difficulties, issues involving patient care,

concerns about technical knowledge and skills (Bailey, 1980; Benoliel, McCorkle, Georgiadou,

Denton, & Spitzer, 1990; Blumenthal, Lavender, &Hewson, 1998; Bourbonnais, Comeau,

Vezina, & Dion, 1998; Robinson, Clements, & Land, 2003).

Family Functioning

The concept of family functioning consists of the quality of relationship between the

members of the family and the information, which reflects the contribution of family members to

life quality (Bulut, 1989). Through the successful performance of the functions of family as a

system, family members can have opportunities for increasing their satisfaction of life, sense of

responsibility, self-confidence, happiness, and productivity. Family functioning is classified as

biological, social, psychological, and economic (Bulut, 1989;Gander& Gardiner, 1995).

An important finding to the study of Turkum et al. (2005) on the Investigation of

University Student’s Perceptions about Family Functioning, the students’ perceptions of family

functioning differ in terms of the behavior they display when they face a problem. Furthermore,

it is found that whereas the students who perceive their family functioning as healthy share their

problems with their mothers, with their fathers, and with their sisters/ brothers, those others who

perceive their family functioning as unhealthy do not share their problems with anybody.

In the study of Kirkham (2011), they emphasized that when a family works together in a

stressful events/situation, they support each other. A few changes may be needed but families are

resilient and can adjust to the changes quickly.Lian and Yusooff (2009) concluded that family

functioning was significantly correlated with the students’ self-esteem. The main hypothesis,

predicted a positive relationship between family functioning and self-esteem was supported.

Identifying an adolescent’s sources of self-esteem is important to the self and is critical to

improving self-esteem.Research reveals that peer approval becomes increasingly important

during adolescence, both adult and peer supports are important influences on the adolescent’s

self-esteem.Research reveals that peer approval becomes increasingly important during

adolescence, both adult and peer supports are important influences on the adolescent’s self-

esteem. According to this study, family function is related to student’s self-esteem and the

important to the self-providing emotional support and social approval, fostering achievement,

and helping adolescent to cope.

According to Muyibi et al., (2010), on their study on the Relationship between

Adolescents’ Family Function with Socio-demographic Characteristics and Behavior Risk

Factors in a Primary Care Facility, they stated that “the family as a unit of care has a great effect in tackling adolescent

problems. Family ties are severely tried during the period when an adolescent is present. In this study, the majority of the

adolescents were rated as having functional families, which might have been due to strong

family interactions and support noted in the African family structure. Provision of routine family

functioning assessment and regular family counseling for dysfunctional families could possibly

stem the trend.”

According to the Western Australian Aboriginal Child Health Survey, there were a lot of

factor that may affect the family functioning. One of these is the importance of

religion/spirituality. The importance placed onreligion/spirituality was associated with their level

of family functioning. Those whostated that religion/spirituality was ‘not at all’ important in

their lives were the groupmost commonly reported to have poor family functioning (34.3 per

cent of thesegroup; CI: 27.9%–41.2%). In contrast, only 17.2 per cent (CI: 14.4%–20.4%)who

regarded religion/spirituality as very important had poor family functioning.

 Another factor is the Family financial strain. The economic wellbeing of families was

strongly related to how well they function. TheWAACHS highlighted that families suffering the

greatest amount of financial strainreported having poor family functioning more often than

familieswith more money at their disposal. Over a third of these group (34.5 per cent;CI: 27.6%–

42.3%) who reported spending more money than they got, had poor familyfunctioning.

It also stated that life stress events can also be a factor. As could be expected, the survey

data point to an association between life stressand family functioning. The proportion of family

reporting poor family functioningincreased from 20.0 per cent (CI: 17.0%–23.2%) when 0–2 life

stress events had been experienced by the group in the last 12 months, to 28.2 per cent (CI:

24.0%–32.9%)when 7–14 life stress events were experienced. Note that the rate of poor

familyfunctioning does not appear to differ appreciably until a large number of life stresses(7–

14) have been experienced (Table 4.41).When the effect of high life stress was further

investigated in a multivariate logisticregression model, it was not found to be independently

associated with the likelihoodof families with Aboriginal children having poor family

functioning.
 CHAPTER 3

Methodology

Population and Sample

The theoretical population for the study will be all regular level III students of the

College of Nursing in UERMMMCI. The investigators chose third year students to control the

variables. Also, their schedule is the same for the investigators to gather data equally. The total

population of regular level III students is 187. The investigators will identify the respondents

using a simple random sampling method. First to determine the sample size, the investigators of

the College of Nursing at UERMMMCI will compute for the numbers of respondents that will be

coming from all regular level III student nurses by doing Slovin’s Formula: n= N / ( 1 + Ne2)

where n is number of samples, N is total population , and e is error tolerance. The investigators

came up with the result of 127 samples from level III student nurses. Secondly, the investigators

will be randomly selecting the respondents in level III. Random selection does ensure that

differences in the attributes of the sample and the population are purely a function of chance.

Altogether the trained enumerators personally will be distributing 127 questionnaires and will be

collecting them on the same day it was distributed.

Setting

The gathering of data will be held at University of the East Ramon Magsaysay Memorial

Medical Center campus during the summer term school year 2011-2012.
Research Design

A descriptive correlational design was employed to this study, because it focuses on

understanding the cause of behaviors, conditions, and situations. It could help into the

investigators’ aim on finding the existence and the degree of a relationship of burnout and

perception of family functioning of level III student nurses of UERMMMCI. In this design, the

investigators would be giving out questionnaires to randomly selected enrolled regular level III

student nurses of UERMMMCI. After gathering the data, the investigators would be analyzing

each answer per question if their expected outcome will come out.

The investigators will not be able to identify each respondent. In case of a low response

rate, they would be sending a reminder. In case of queries, respondents can get in touch with

them through the electronic mail.

The strengths of the investigators’ study design are that it is often an efficient means of

collecting a large amount of data about a problem. Data on all variables will be only collected

once. This design often strong in realism and therefore has an intrinsic appeal for solving

practical problems. Also it is seldom criticized for its artificiality. On the other hand, the

limitation of the study is that it is susceptible to faulty interpretation and weak ability to reveal

causal relationships.

The independent variable includesburnout and dependent variable is perception of family

functioning.
Methods

The investigators are going to use simple random sampling among randomly selected

level III student nurses of UERMMMCI. This sampling method was selected because the

investigators are going to establish a sampling frame, the technical student numbers for the list of

the elements from which the sample will be chosen. Once a sampling frame has been developed,

elements are numbered consecutively. A table of random numbers would then be used to draw a

sample of the desired size. This could be done by the investigators would find a starting place in

a table of random numbers by blindly placing their finger at some point on the page. Selected

respondents would be answering the given questionnaire. Lastly after they have answered the

questionnaire, the investigators would be collecting it and will be interpreting the answers based

on their criteria which would still be developed.

Measures

The investigators will be utilizing two survey questionnaire for the collection of data. The

first part of the survey questionnaire will be the Maslach Burnout Inventory (Student-Survey)

(MBI-SS; Schaufeli et al, 2002): This scale, designed to measure the burnout level of students,

contains of 15 items which evaluate the dimensions of Emotional Exhaustion (EX) which

measures feelings of being emotionally overextended and exhausted by one's work, Cynicism

(CY) which measures an unfeeling and impersonal response toward recipients of one's service,

care treatment or instruction, and professional efficacy(EF) which measures feelings of

competence and successful achievement in one's work. Student must indicate the level of

agreement with every item, which were scored on a 7-point frequency rating scale ranging from

0: Never to 6: Always.The MBI provides three scores that represent the sum of scores of the
individual items pertaining to each of the three separate subscales. Results are reported in terms

of a high, moderate and low degree of burnout depending on the respective sores for each

measure. A high degree of burnout (61-90)is reflected in high scores on the EE and DP subscales

and in low scores on the PA subscale which is rated inversely. An average degree of burnout

(31-60)is reflected in average scores on the three subscales, and a low degree of burnout is

reflected in low scores on the EE and DP subscales and a high score on the PA subscales

(Maslach et al., 1986). A low degree of burnout (0-30) therefore represents a positive

psychological condition rather than the stereotypical negative condition that is widely associated

with the burnout syndrome In the first form of MBI-SS reliability of this inventory through the

method of internal consistency in sample of Dutch, Portugal and Spanish has been reported:

Spanish sample (EX 0/74, CY 0/79, EF 0/76). Portugal sample (EX 0/79, CY 0/82, EF 0/69).

Dutch sample (EX 0/80, CY 0/86, EF 0/67). In Iran, Rostami et al. (2011) examined reliability of

this scale with methods: internal consistency method and test-retest. Coefficient Cronbach's

alpha for the EX, CY and EF respectively was 88, 90, 84 and show good internal consistency and

(0/78) for. test-retest reliability about 4 weeks later, obtaining a reliability coefficient of 0/89,

0/84 and 0/67 respectively for EX, CY and EF, which result show the good stability of the tool.

The Concurrent validity of this tool also with the University Depression Inventory (USDI) is

confirmed.

The second part of survey questionnaire for the collection of data is the Family APGAR

scale. The Family APGAR was developed in 1978 but it was used by recently studies such as

Relationship between adolescents’ family function with socio-demographic characteristics and

behavior risk factors in a primary care facility by Abu S. Muyibi (2010) and Differences in
Perceived Stress and Its Correlates Among Students In Professional CoursesbyManeAbhay B.

(2011).The Family APGAR is a useful instrument to this study to provide reliable family

information. Smilkstein defined the family in terms of commitment and the sharing of resources

such as time, space and finances. The investigators purpose is to assess a family member’s

perception of family functioning by examining his/her satisfaction with family relationships. The

Family APGAR assessment tool is comprised of 5 questions that assess the patient’s satisfaction

with current family function and support provided by his/her family. The five items are related to

the following components of satisfaction with family function: Adaptability, Partnership,

Growth, Affection, and Resolve. Format three choices are provided: 0 = hardly ever, 1 = some of

the time and 2 = almost always. Total: 8-10 -highly functional, 4-7 –moderately dysfunctional

and 0-3 –severely dysfunctional. Reliability of this tool was also identified. Several studies have

demonstrated internal consistency. Administration of the Family APGAR to college students

(average age, 19.7 years) provided initial reliability data. Chronbach’s of 0.80 or greater are

consistently reported, with the use of the 5-choice format yielding higher internal consistency.

No significant differences were found between the scores of men versus women Cronbach’s

alpha values reported across studies using Family APGAR have ranged from .80 to .85, and

item-to-total correlations ranged from .50 to .65 (Smilkstein, 1978).The author’s initial

assessment of validity was to establish correlations with the previously validated instrument, the

Pless-Satterwhite Index, as well as with clinician reports. The former yielded a correlation of .80,

the latter .64 (Smilkstein, 1978). The Family APGAR questionnaire has been used in numerous

studies (mostly clinical) investigating family functioning. A literature search using PsychInfo

yielded 16 articles in the past ten years that have used the Family APGAR. In clinical practice,
Family APGAR scores have been associated with physician visits, immune responses, emotional

distress and depressive symptoms (Bluestein, 1993; Clover, 1989; Greenwald, 1999).

The authors’ permission prior to the used of the said tools was utilized by asking

permission through email where they agreed upon.

Ethical Considerations

During subject recruitment and selection investigators will obtain informed consent that

guide the principle that participation in a research study must be voluntary. This means that all

participants will be informed about the purpose of the study and any risk they may encounter,

and must freely agree to participate. Investigators will provide participants information about the

study, before prospective participants can consider volunteering for a study, to allow participants

to make a free and informed choice. The information includes descriptions of the precise nature

of participation, the duration of the participation, the nature of the data to be collected, how the

data will be stored and reported, the nature of any possible risk to which participants might be

exposed, and how participants can withdraw once the study has begun. Coercion will also be

eliminated to allow the participant to volunteer freely to be part of a study; potential participants

must feel that they are under no pressure to participate. Investigators will also going to avoid

deception through asking questions straight-forward.

During Treatment and Data Collection,the investigators will cause no harm to the

participants. The investigators will maintain participant anonymity to maintain data

confidentiality of participants to furnish information anonymously. Maisntenance of integrity

of data will also be done by storing data against any violations of confidentiality as well as
falsification and contamination of data. Investigators will avoid invasions of privacy by not

asking questions, or generally collect data that are not essential to the purpose of the study.

Permit participants to withdraw will be explained to the participants.

During Data Analysis and Interpretation, again investigators will also maintain the

participant anonymity and the integrity of the data.

Treatment of Data

The appropriate statistical test to be used in the investigator’s study is the Correlation

Coefficient Test (Pearson's r). The study is a quantitative one and it is a technique used for

investigating the relationship between two quantitative, continuous variables. Pearson's

correlation coefficient (r) measures the strength of the association between the two variables.

This correlation coefficient designating the magnitude of relationship between 2 variables

measured in at least an interval scale. Pearson's r is a useful descriptor of the degree of linear

association between two variables in the study, the burnout being experienced by the student

nurses of UERMMMCI (independent variable) and the second one is their perception of family

functioning (dependent variable). It has two key properties of magnitude and direction. Pearson's

correlation is used when we have two quantitative variables and the research hypothesis predicts

whether there is a linear relationship between these two quantitative variables. It can be a

positive or negative relationship, as long as it is significant. When there is a relationship between

two variables, there can be a positive or negative correlation. It cannot be used when we retain

the null hypothesis because then there is no relationship. It can be used if the null is rejected.

This test can be used to predict relationships in longitudinal studies or to identify

relationships between variables.