Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

Age and burnout syndrome in nursing

professionals: moderating role of emotion-focused
coping

Philip Chukwuemeka Mefoh, Eze Nsi Ude & JohBosco Chika Chukwuorji

To cite this article: Philip Chukwuemeka Mefoh, Eze Nsi Ude & JohBosco Chika Chukwuorji
(2018): Age and burnout syndrome in nursing professionals: moderating role of emotion-focused
coping, Psychology, Health & Medicine, DOI: 10.1080/13548506.2018.1502457

To link to this article: https://doi.org/10.1080/13548506.2018.1502457

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PSYCHOLOGY, HEALTH & MEDICINE
https://doi.org/10.1080/13548506.2018.1502457

Age and burnout syndrome in nursing professionals:

moderating role of emotion-focused coping
Philip Chukwuemeka Mefoha, Eze Nsi Udeb and JohBosco Chika Chukwuorji a

a
Department of Psychology, University of Nigeria, Nsukka, Enugu state, Nigeria; bDepartment of
Ophthalmology, Federal Teaching Hospital, Abakaliki, Ebonyi state, Nigeria

ABSTRACT ARTICLE HISTORY

This study examined whether the association between age and Received 27 January 2018
the three burnout dimensions (emotional exhaustion, depersona- Accepted 16 July 2018
lisation and reduced personal accomplishment) depend on the KEYWORDS
extent of nursing professionals’ use of emotion-focused coping Age; burnout; coping;
strategy. Participants were 283 nurses (Mage = 35 years, nursing; quality of life
SD = 8.17, Range = 23–66 years) from a tertiary healthcare institu-
tion in south-eastern Nigeria. They completed self-report measures
of relevant variables in paper and pencil form. Increased age was
associated with reduced personal accomplishment for nurses with
high emotion-focused coping, but not for those who were low or
moderate in use of emotion-focused coping. Such moderation
effects were not found for emotional exhaustion and depersona-
lisation. Findings clarify the conditions under which age may be
associated with reduced sense of achievement at work among
nursing professionals. The study adds to knowledge in combating
burnout in nursing and could guide health managers in develop-
ing strategies that might prevent or ameliorate nurses’ burnout.

Burnout is a psychological strain due to prolonged response to chronic work stress

(Maslach & Jackson, 1981), which is characterised by emotional exhaustion, deperso-
nalisation and reduced personal accomplishment (Maslach, Jackson, & Leiter, 1996).
Even though it occurs in most work environments, healthcare professionals, especially
nurses have the greatest risk of burnout (Biksegn, Kenfe, Matiwos, & Eshetu, 2016;
Iglesias & De Bengoa, 2013). In general, burnout in healthcare personnel negatively
affects healthcare efficiency (Joaquim et al., 2018; Mattei, Fiasca, Mazzei, Abbossida, &
Bianchini, 2017), and it ‘could potentially put patients at risk and pose a major issue in
patient safety’ (Bugaj et al., 2016, p.24), implying that preventing or alleviating nurse
burnout may contribute to improving nurses’ health-related quality of life and quality
of care in hospitals.
Researchers have investigated the factors that contribute to burnout, including job-related
factors (Rizo-Baeza et al., 2017; Sinclair et al., 2015), psychological variables (Gomez-Urquiza
et al., 2016; Jaracz et al., 2017), and socio-demographic characteristics (Akman, Ozturk,
Bektas, Ayar, & Armstrong, 2016; Huri et al., 2017). Age is one of the key individual predictor

CONTACT JohBosco Chika Chukwuorji johnbosco.chukwuorji@unn.edu.ng Department of Psychology,

University of Nigeria, 41000, Nsukka, Enugu state, Nigeria
Supplemental data for this article can be accessed at here
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 P. C. MEFOH ET AL.

variables in burnout (Roche & Ogden, 2017). In a recent meta-analysis of 51 studies, Gomez-
Urquiza, Vargas, De La Fuente, Fernandez-Castillo, and Cañadas-De La Fuente (2017) found
that older nurses reported lower emotional exhaustion and depersonalization than younger
nurses, but the association of age with reduced personal accomplishment was not significant.
Gomez-Urquiza et al. suggested that research is needed on the moderators between age and
burnout which has necessitated the current study.
Coping is a strong moderator variable (Li et al., 2017), and a meta-analysis on coping
and burnout suggested that coping may interact with demographic factors such as age
(see Shin et al., 2014). Emotion-focused coping strategy in particular, has shown con-
sistently strong association with emotional exhaustion and depersonalization (See Shin
et al., 2014). Evidence has also shown that more nurses employ greater emotion-focused
coping strategies than problem-focused coping strategies (Ramezanli, Koshkaki,
Talebizadeh, Jahromi, & Jahromi, 2015). Therefore, research accounting for the role of
emotional coping in the relationship between age and burnout symptoms among nurses
is worthwhile. Findings from such a study can be of immense value in understanding
nurse burnout and can be utilised in formulating policies aimed at designing interven-
tions to address the problem. Therefore, the central aim of this study is to explore whether
emotion-focused coping strengthens or weakens the relationship between age and burn-
out. We hypothesised that older nurses who utilise more emotion-focused coping style
will have higher levels of emotional exhaustion, depersonalisation, and reduced personal
accomplishment than older nurses with less use of emotion-focused coping.

Method
Sample and procedure
Participants were 283 nurses drawn from Federal Teaching Hospital, Abakaliki (FETHA),
which is a tertiary healthcare institution in south-eastern Nigeria. Inclusion criteria were as
follows: registered nurse, ability to read and understand English language, and current
engagement as a provider of direct patient care in the work setting. The total number of
eligible nurses in the hospital was 1005. With 5% margin of error, 95% confidence interval,
and burnout prevalence of 48% in Nigerian nurses (see Okwaraji & Aguwa, 2014), the
obtained sample size in this study had a power of 80%, which was considered adequate.
Respondents’ ages ranged from 23 to 66 years with a mean age of 35 years (SD = 8.17). By
gender, there were 43 (15.2%) men and 240 (84.8%) women. They were mostly married
persons 72.1%, but a few were were single (26.9%) and separated (1.1%).
Approval for the study was granted by the research ethics committee of the
Federal Teaching Hospital, Abakaliki, and the psychology research committee of
University of Nigeria, Nsukka. All procedures performed in this study were in
accordance with the ethical standards of the approving research committee, and
with the 1964 Helsinki declaration and its later amendments or comparable ethical
standards. Five student nurses were recruited and trained by the second author for
the purpose of data collection. Eligible nurses were approached in the clinics and
wards. The purpose of the study was explained to them. In order to ensure anon-
ymity/confidentiality, the nurses were informed that their name(s) was not required
in completing the questionnaire. Nurses who consented to take part in the study
 PSYCHOLOGY, HEALTH & MEDICINE 3

were given the paper and pencil questionnaire form for completion. The research
assistants were on ground in the setting to inspect the questionnaire and participants
were encouraged to provide every required information in the form before returning
the questionnaire.

Measures
The 12-item Emotion-focused coping subscale of Coping Assessment Scale (CAS) (Moos
& Billings, 1982) was used to assess attempts by nurses to handle emotions aroused by a
stressor. Responses were made on a 4-point Likert scale format ranging from 1 (I have not
been doing this at all) to 4 (I have been doing this a lot). The psychometric properties of
the scale have been reported in a previous research (e.g., Billings & Moos, 1984). The
internal consistency reliability estimate (α) of the scale was .75 in the present study.
We measured burnout using the 22-item Maslach Burnout Inventory – Human
Services Survey (MBI-HSS) (Maslach & Jackson, 1981) which assesses the three burnout
dimensions: emotional exhaustion, depersonalization, and reduced personal accomplish-
ment. The response format ranges from ‘never’ (0) to ‘everyday’ (6). Items representing
reduced personal accomplishment are reverse-scored. Maslach and Jackson (1981)
reported α reliability coeffcients of .90 (emotional exhaustion), .79 (depersonalisation),
and .71 (reduced personal accomplishment). The MBI-HSS have shown good reliability
and validity among Nigerian nurses (Enukorah, 2010; Lasebikan & Oyetunde, 2012).
Internal consistency (α) reliability of the MBI-HSS in the present study was .71.

Data analysis
Data were entered into the Statistical Package for the Social Sciences (SPSS) version 20©.
Hayes PROCESS Macro for SPSS was used in analysing the data and testing the hypotheses.
The PROCESS macro is currently the gold standard in tests of moderation hypotheses
because in addition to other advantages, it simultaneously tests direct and interaction
effects (See Hayes, 2013). It has been used for similar statistical analyses in tests of
moderation hypotheses (e.g., Nwoke, Chukwuorji, & Ebere, 2016; Wendsche, Hacker
Wegge, & Rudolf, 2016; Zhou et al., 2016).

Results
Table 1 showed that age was not significantly associated with emotional exhaustion
(B = -.05, p = .412). Emotion focused coping was positively associated with emo-
tional exhaustion (B = .32, p = .008), indicating that for every one unit rise in
emotion-focused coping, emotional exhaustion increases by .32 units. Emotion-
focused coping did not moderate the relationship between age and emotional
exhaustion (B = -.01, p = .737).
Age was not significantly associated with depersonalisation (B = -.01, p = .777). Emotion
focused coping was positively associated with depersonalisation (B = .18, p = .008), indicat-
ing that for every one unit rise in emotion-focused coping, depersonalisation increases by
.18 units. Emotion-focused coping did not moderate the relationship between age and
depersonalisation (B = -.01, p = .378).
4 P. C. MEFOH ET AL.

Table 1. Hayes PROCESS results predicting the burnout dimensions by age and emotion-focused
coping (N = 283).
Emotional Exhaustion Depersonalisation Reduced Personal Accomplishment
Variables B SE t p 95%CI B SE t p 95%CI B SE t p 95%CI
Age −.05 .06 −.82 .412 [.07,-.17] −.01 .04 −.29 .777 [.06,-.08] −.02 .06 −.26 .792 [-.11,.14]
EFC .32 .12 2.60 .008 [.56,1.08] .18 .07 2.69 .008 [.05,.30] −.10 .13 −.77 .445 [-.16,.37]
Age X EFC −.01 .01 −.34 .737 [-.03, .02] −.01 .01 −.88 .378 [-.03,.01] .03 .01 2.05 .041 [.00,.05]
Note. EFC = Emotion-focused coping

Age was not significantly associated with reduced personal accomplishment (B = -.02,
p = .792). Emotion focused coping was not significantly associated with reduced personal
accomplishment (B = -.10, p = .445). The interaction effect of age and emotion-focused
coping on reduced personal accomplishment was significant (B = .03, p = .041), indicating
that emotion-focused coping moderated the relationship between age and reduced
personal accomplishment. Further probing of the interaction (See Figure 1) showed
that for those with low and moderate emotion-focused coping, age was negatively
associated with reduced personal accomplishment. For persons with high emotion-
focused coping, age was positively associated with reduced personal accomplishment.
Thus the pattern of association between age and reduced personal accomplishment
changes as function of nursing professionals’ level of emotion-focused coping.

Discussion
We tested whether the nature of association between age and the dimensions of
burnout depend on the extent of nursing professionals’ use of emotion-focused coping
strategy. Emotion-focused coping was found to be a significant moderator of the

Figure 1. Graphs of the interaction showing the moderation effect of emotion-focused coping on
age and reduced personal accomplishment.
Note: Low = −1SD below mean, Moderate = at mean, High = + 1SD above mean.
 PSYCHOLOGY, HEALTH & MEDICINE 5

relationship between age and reduced personal accomplishment, such that older age
was associated with reduced personal accomplishment for persons with high emotion-
focused coping, whereas the younger age was associated with reduced personal accom-
plishment among those who were low or moderate in use of emotion-focused coping.
The moderating role of emotion-focused coping on the relationship between age and
reduced personal accomplishment clarifies the conditions under which age may be
associated with inefficacy among nursing professionals. It was the older persons who
utilised more emotion-focused coping that were most likely to have reduced sense of
achievement in their work than the younger persons. In other words, even as high
emotion-focused coping is ineffective in burnout prevention, it has the worst outcomes
for the older nurses in relation to their personal accomplishment at work. Due to the
differences in impact of emotion-focused coping on reduced personal accomplishment
among nurses on account of age, it is suggested that interventions to ameliorate
reduced personal accomplishment should target younger nurses who adopt low emo-
tion-focused coping. More so, older nurses who adopt high emotion-focused coping
should also be made to understand and apply more proactive coping strategies in order
to alleviate reduced personal accomplishment.
The significance of the present study is the investigation of interactive roles of age
and emotion-focused coping in burnout among nursing professionals. This is consid-
ered an important contribution to the existing literature, particularly as the population
was drawn from a developing country. However, the study has some limitations,
including its cross-sectional design, use of self-report measures, and our inability to
obtain information on the nursing specialties of the nurses who participated in this
study. Nursing specialty may have made some difference in burnout (see Browning
et al., 2007). Hours worked per week, and number of patients cared for during the last
shift may also be critical factors, but we had no information about them from the data.
In conclusion, despite these limitations, this study has provided a first attempt to
explore the moderating role of emotion-focused coping on age association with burnout
syndrome among nurses.

Acknowledgments
The authors are grateful to Chief C. C. Ogbu (Director of Administration, Federal Teaching
Hospital, Abakaliki), Mrs. Ude Nnenna Nsi, and all the nurses who volunteered to take part in
the study.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
No external funding or support was received by the authors for this study.
6 P. C. MEFOH ET AL.

ORCID
JohBosco Chika Chukwuorji http://orcid.org/0000-0003-4065-4327

References
Akman, O., Ozturk, C., Bektas, B., Ayar, D., & Armstrong, M. A. (2016). Job satisfaction and
burnout among paediatric nurses. Journal of Nursing Management, 24(7), 923–933.
Biksegn, A., Kenfe, T., Matiwos, S., & Eshetu, G. (2016). Burnout status at work among health
care professionals in a tertiary hospital. Ethiopian Journal of Health Sciences, 26(2), 101–108.
Billings, A. G., & Moos, R. H. (1984). Coping, stress, and social resources among adults with
unipolar depression. Journal of Personality and Social Psychology, 46(4), 877–891.
Browning, L., Ryan, C. S., Thomas, S., Greenberg, M., & Rolniak, S. (2007). Nursing specialty and
burnout. Psychology, Health & Medicine, 12(2), 148–154.
Bugaj, T. J., Cranz, A., Junne, F., Erschens, R., Herzog, W., & Nikendei, C. (2016). Psychosocial
burden in medical students and specific prevention strategies. Mental Health & Prevention, 4
(1), 24–30.
Enukorah, F. C. (2010). Role of stress and age on psychological burnout among nurses. Nigerian
Journal of Psychological Research, 6, 75–82.
Gomez-Urquiza, J. L., Aneas-Lopez, A. B., De La Fuente-Solana, E. I., Albendi´n-Garci´a, L., Di
´az-Rodriguez, L., & Canadas-De La Fuente, G. A. (2016). Prevalence, risk factors and levels of
burnout among oncology nurses: A systematic review. Oncology Nursing Forum, 43, E104–
E120.
Gomez-Urquiza, J. L., Vargas, C., De La Fuente, E. I., Fernandez-Castillo, R., & Cañadas-De La
Fuente, G. A. (2017). Age as a risk factor for burnout syndrome in nursing professionals: A
meta-analytic study. Research in Nursing & Health, 40, 99–110.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A
regression-based approach. New York, NY: Guilford Press.
Huri, M., Bağiş, N., Eren, H., Başibüyük, O., Şahin, S., Umaroğlu, M., & Orhan, K. (2017).
Burnout and occupational participation among dentists with teaching responsibilities in
universities. Psychology, Health & Medicine, 22(6), 693–700.
Iglesias, L. M. E., & De Bengoa, B. R. (2013). Prevalence and relationship between burnout, job
satisfaction, stress and clinical manifestations in Spanish critical care nurses. Dimensions of
Critical Care Nursing, 32, 130–137.
Jaracz, M., Rosiak, I., Bertrand-Bucińska, A., Jaskulski, M., Nieżurawska, J., & Borkowska, A.
(2017). Affective temperament, job stress and professional burnout in nurses and civil
servants. PLoS ONE, 12(6), e0176698.
Joaquim, A., Custódio, S., Savva-Bordalo, J., Chacim, S., Carvalhais, I., Lombo, L., & Gomes, R.
(2018). Burnout and occupational stress in the medical residents of oncology, haematology
and radiotherapy: A prevalence and predictors study in Portugal. Psychology, Health &
Medicine, 23(3), 317–324.
Lasebikan, V. O., & Oyetunde, M. O. (2012). Burnout among nurses in a Nigerian general
hospital: Prevalence and associated factors. International Scholarly Research Network (ISRN)
Nursing, 2012, 1–6. doi:10.5402/2012/402157
Li, L., Ai, H., Gao, L., Zhou, H., Liu, X., Zhang, & Fan, L. (2017). Moderating effects of coping on
work stress and job performance for nurses in tertiary hospitals: A cross-sectional survey in
China. BMC Health Services Research, 17, 401–409.
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of
Organizational Behavior, 2, 99–113.
Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual (3rd ed.).
Palo Alto, CA: Consulting Psychologists Press.
 PSYCHOLOGY, HEALTH & MEDICINE 7

Mattei, A., Fiasca, F., Mazzei, M., Abbossida, V., & Bianchini, V. (2017). Burnout among
healthcare workers at L’Aquila: Its prevalence and associated factors. Psychology, Health &
Medicine, 22(10), 1262–1270.
Moos, R. H., & Billings, A. G. (1982). Conceptualizing and measuring coping resources and
processes. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical
aspects (pp. 212–230). New York: Free Press.
Nwoke, M. B., Chukwuorji, J. C., & Ebere, M. O. (2016). Number of dependents, community
support, and mental health in later life: Does gender make a difference? The International
Journal of Aging and Human Development, 83(1), 63–87.
Okwaraji, F. E., & Aguwa, E. N. (2014). Burnout and psychological distress among nurses in a
Nigerian tertiary health institution. African Health Sciences, 14(1), 237–245.
Ramezanli, S., Koshkaki, A. R., Talebizadeh, M., Jahromi, Z. B., & Jahromi, M. K. (2015). A study
of the coping strategies used by nurses working in the intensive care units of hospitals
affiliated to Jahrom University of medical sciences. International Journal of Current
Microbiology and Applied Sciences, 4(4), 157–163.
Rizo-Baeza, M., Mendiola-Infante, S. V., Sepehri, A., Palazón-Bru, A., Gil-Guillén, V. F., &
Cortés-Castell, E. (2017). Burnout syndrome in nurses working in palliative care units: An
analysis of associated factors. Journal of Nursing Management, Online First. doi:10.1111/
jonm.12506
Roche, A., & Ogden, J. (2017). Predictors of burnout and health status in Samaritans’ listening
volunteers. Psychology, Health & Medicine, 22(10), 1169–1174.
Shin, H., Park, Y. M., Ying, J. Y., Kim, B., Noh, H., & Lee, S. M. (2014). Relationships between
coping strategies and burnout symptoms: A meta-analytic approach. Professional Psychology:
Research and Practice, 45(1), 44–56.
Sinclair, R. R., Sliter, M., Mohr, C. D., Sears, L. E., Deese, M. N., Wright, R. R., & Jacobs, L.
(2015). Bad versus good, what matters more on the treatment floor? Relationships of positive
and negative events with nurses’ burnout and engagement. Research in Nursing & Health, 38,
475–491.
Wendsche, J., Hacker Wegge, J., & Rudolf, M. (2016). High job demands and low job control
increase nurses’ professional leaving intentions: The role of care setting and profit orientation.
Research in Nursing & Health, 39(5), 353–363.
Zhou, J., Yang, Y., Qiu, X., Yang, X., Pan, H., Ban, B., & Wang, W. (2016). Relationship between
anxiety and burnout among Chinese physicians: A moderated mediation model. PLoS ONE,
11(8), e0157013.