Chapter 2

This chapter includes the ideas and generalization or conclusions of various

research studies. Those that were induced in this chapter helped in familiarizing

information that is relevant and similar to the present study.

Review of Related Literature

On occupational burnout. According to Psychology Today (2021), burnout is the

state of mental, emotional, and physical weariness brought upon by prolonged or repeating

stressors. It can be experienced through various areas of life, like parenting and caretaking,

but is most commonly experienced through problems at work. Tavakoli, et. al. (2018)

indicated that job burnout is significant in health-related professions due to its

environmental stressors such as aggression, violence at work, work overload, and the like.

According to Maciel (2017), occupational burnout syndrome arises from chronic stress

related to work. Ezenwaji et.al (2019) stated that individuals who are exposed to stress on

a regular basis are more likely to develop burnout syndrome than those who are not and

nurses who are severely stressed could render poor quality of service, which can lead to

low patient satisfaction. According to Caimpi R.C (2019), a person exposed to stress, who

is unable to adjust, for such a long time, may feel unmotivated and hopeless. Therefore,

excessive continuous stress causes burnout, which causes a state of emotional and physical

weariness. Nursing burnout is a common condition characterized by exhaustion or fatigue,

dread going to work, feeling unvalued and being continually overworked, Kaple (2021).

On emergency room nurses. Emergency room nurses treat patients suffering from

trauma, injury, or severe medical conditions requiring urgent treatment; more than that they
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work in crisis situations that require quick thinking and expert skills (Brooks, 2018).

Thomas (2016) determined that emergency room nurses encounter emotional fatigue and

depersonalization on the account of a fast-moving environment accompanied by an

imbalanced work-recovery physiological state. With their distinct experience from other

specialties and a bustling environment, emergency room nurses tend to be exposed to

various stressors, like brutal events and constantly changing frenzied work conditions, that

are not usually experienced by other fields that have led them to become burnouts.

According to Rozo J.A. et al (2017), emergency room nurses are at risk for experiencing

burnout due to the fast-paced nature of their work and demanding field. A recent study

showed that 126 out of 130 nurses or 93% of emergency room nurses suffer from burnout

(Jameel F., et al, 2021).

On emergency room nurses with occupational burnout. Job burnout is

ubiquitous in the nursing practice, particularly in the emergency department (Tavakoli, et.

al., 2018). A fast-paced environment can cause emotional and physical problems towards

the nurse which could affect the quality of patient care given and patient outcomes.

Hamdan M. & Hamra, A.A. (2017) stated that burnout is common among emergency

department nurses and has been ascribed to shortage of supplies and materials, and the

nature of care along with witnessing the suffering and pain of others. And also attributed

to high work pressure

Nurse burnout occurs when the stress of the job creates physical, mental and

emotional exhaustion as stated by Nurse Journal Staff (2021). Occupational stress among

nurses is most commonly caused by unanticipated situations or challenges that necessitate

personal involvement and undertaking tasks that do not correspond to one’s knowledge,
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skills or expectations, resulting in the person’s inability to manage the situation, Dobnik

(2018).

On delivery of care and work efficiency. Jun, et. al. (2021) stated that worsening

safety and quality of care, decreased patient satisfaction, and nurses’ organizational

commitment and productivity are effects of nurses’ burnout. Nurse burnout is an

occupational hazard affecting nurses, patients, organizations, and society at large. Hall, et.

al. (2016) added that poor safety outcomes such as medical errors are associated with poor

wellbeing and moderate to high levels of burnout of healthcare staff. Khomami H.M and

Rusimfram (2019) stated that nurses have the obligation to adhere to their professional

codes of ethics and offer the best quality of care for patients in accordance with the set

standard. Nursing efficiency is more than just efficient utilization of resources, it includes

a skilled standard of care and effective interpersonal relationship and communication.

Mudallal et. al. (2017) determined that among nurses, burnout is a common psychological

phenomenon. It is characterized by a decline in physical, emotional, and psychological

energy resulting from work-related stress that leads to cynicism towards clients and

colleagues and feelings of low self-efficacy. To add, nurse burnout is described as a

decrease in nurses’ energy, which displays as emotional tiredness, lack of motivation and

feeling of frustration, and may result in decrease in job efficiency. A healthy, safe and

friendly work environment, as well as effective work organization, promote self-efficacy

and reduce or eliminate the factors that cause the onset of burnout symptoms, all of which

have a significant influence on increasing job quality, Nowakowska et al. (2016).

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Review of Related Studies

Nurse burnout is a problem widely affecting medical professionals in the long run.

Studies have illustrated that nurses experiencing burnouts are more likely to make

mistakes. It was noted that emergency room nurses are unlike other specialties due to

exposure to severe stressors such as violent events and constantly changing frenzied work

conditions. The rise of emergency room patients, accompanied by the lack of emergency

room staff nurses, has led to the overburdened staff in the emergency room. Excessive

work and inadequate recovery time may also have contributed to the nurses’ burnout.

According to Thomas (2016), there is an association between the safety of patients and

nurse burnouts.

Rozo J.A. et al. conducted a study in 2017 focusing on situational factors associated

with burnout among emergency department nurses. A phenomenological approach

together with a purposive sampling was utilized where five sets of interviews were

conducted. Participants were selected based on the following criteria: (1) they had

emergency department nursing experience, (2) reported work-related stress, (3) spoke

English, and (4) were 18 years old and older. Data saturation was reached during the fourth

and fifth interviews as responses were repetitive. The aim of the study was to understand

lived experiences and factors that may lead to burnout among ED nurses.

Hamdam M. & Hamra, A.A (2018) conducted a study in Palestine that aimed to

evaluate burnout levels and associated factors among workers in the emergency room. Data

was collected using a self-administered questionnaire. Due to the small number of

emergency department workers, all employees of the selected hospitals were targeted.

There was an estimate of 596 workers, but those who had one year in the emergency
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department and trainees were excluded in the study. Therefore, a total of 444 workers

participated, 161 of which were nurses, 142 were physicians, and 141 were administrative

personnel. Burnout was measured through the widely used Maslach burnout inventory-

human services survey. The MBI-HSS measures burnout using 22 items grouped in three

scales: emotional exhaustion (9 items), depersonalization (5 items), and personal

accomplishments (8 items). Data was collected by trained researchers. Surveys were

administered to the participants and collected back in sealed envelopes. Burnout in the

Emergency department would also assess the association between violence as a cause

(Hamdam M. & Hamra, A.A., 2017).

In 2016, Thomas conducted a study on emergency room nurse burnouts that

identified factors that can contribute to nurse burnout including job dissatisfaction and

workplace bullying. This study employed random sampling via semi-structured interviews

using research questions. 15 male and female nurses ranging from the ages of 25 to 75

among Queen of Angels Trauma Center emergency room nurses were randomly selected.

Data was translated using a grounded theory method. This study focused on the

participants’ behaviors, like social interaction between nurses, contact with patients, and

the effects of the emergency room work environment towards nurses. Thus, the study

emphasized emergency room nurse burnouts and its factors.

In 2020, Xie C. et al. conducted an experimental study on ICU nurses experiencing

occupational burnout. This sought to compare educational intervention and mindfulness-

intervention in relieving the burnout of the participants through a parallel, controlled trial.

The study stated that nurses have a high incidence of occupational burnout prompting the

researchers to explore interventions in order to enhance coping resources. One hundred and
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six (106) nurses in two (2) different Intensive Care Units were screened and a total of 91

nurses underwent the program consisting of the Maslach Burnout Inventory, Acceptance

and Action Questionnaire II, and the Mindfulness Attention Awareness Scale. The tests

were administered a total of four (4) times during the study, T0 before the intervention, T1

one week after the intervention, T2 one month after the intervention, and T3 three months

after the intervention. In order to observe the effects of mindfulness-based intervention, the

data was analyzed through intention-to-treat analysis and repeated measures.

Tavakoli et al (2018) conducted a study that aims to know the effects of job burnout,

stress and satisfaction to the quality of care, patient outcomes and retention of emergency

staff nurses. The data was collected and gathered using a standard questionnaire and

individuals acted as an interviewer in conducting this study. This research selected 10

public educational hospitals in Tehran, Iran consisting of 788 employed emergency

department nurses which were all targeted and four questionnaires were used in conducting

this study. The first questionnaire contained the demographic information of the nurses,

second is an assessment of burnout using the Maslach Burnout Inventory consisting of 22

questions, third is the hospital stress scale (HSS-35) to measure job stress that consists of

35 questions and lastly the job description index (JDI) scale was used to measure the job

satisfaction of emergency nurses. Pearson correlation coefficient was used to know and

examine the relationship between the 3 variables in this study. Age, marital status,

educational level, and employed status were the baseline characteristics of the studies of

nurses.

Li et al. (2021) conducted a study exploring the relationship between occupational

stress, job burnout and quality of life among surgical nurses in Xinjiang, China. According
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to this study, chronic and excessive stress has detrimental effects to physical and mental

health which also affects their efficiency and quality of work. The study used a cluster

random sampling method and surveys were carried out between May to September of 2019

in the five affiliated hospitals of Xinjiang Medical University. The research selected 10

random surgical nurses from the surgical department of these hospitals. The criteria for

selecting these nurses are the following: (1) 18-60 years old; (2) employed at the hospital

for at least six months; (3) clinical surgical nurses with nurse qualification certificate and

registered on duty; (4) informed consent provided by the nurses and voluntary participation

in the study. The researchers distributed a total of 550 questionnaires with 488 valid

questionnaires retrieved. Surgical nurses were chosen as they encounter patients who have

undergone surgery and trauma with changeable diseases requiring them to have a greater

capacity to bear certain strains they may encounter in their work. The nursing staff in the

selected tertiary hospitals had working hours that involved three shifts with no fixed break

times. The study stated that surgical nurses are prone to occupation stress and burnout as

they have high work intensity and heavy tasks involved in their occupation. Thus, the study

aimed to clarify the relationship between these variables, occupational stress, job burnout,

and quality of life in order to contribute to the formulation of effective intervention

measures for nurses.

In light of previous studies, the increased insight on occupational burnout in the

nursing profession, the factors that may contribute to its development and its effects, will

provide a better understanding of the occurrence and experiences of emergency room

nurses facing burnout.