Methods and Measurement

Nursing burnout affects a considerable proportion of nurses, and is caused by heavy workloads, inadequate staffing, and workplace stress. The use of evaluation tools like Maslach Burnout Inventory and the Nursing Stress Scale is an effective method to assess the quality of the proposed intervention. The LEAN model can be applied to change in nursing practice to reduce burnout and improve processes and outcomes.

NURS FPX 8030 Assessment 4 Methods and Measurement

Instruments for Evaluation of Implementations Plan

A Director of Clinical Operations and Nursing Excellence at a healthcare setting should assess the applicability of an intervention proposed to resolve the issue of stress and burnout in nurses. This can be done using the appropriate tools or scales for assessment.

The Maslach Burnout Inventory is a gold standard and widely used tool for measuring burnout in healthcare professionals, including nurses, and it consists of three subscales: emotional exhaustion, depersonalization, and personal accomplishment (Williamson et al., 2018). Christina Maslach and Susan E. Jackson created the first version of the MBI. By using this instrument, the effectiveness of the intervention can be evaluated in terms of changes in scores on each of these subscales. This instrument is appropriate because it has been approved through extensive research of more than twenty-five years, and has proved its reliability (Erwan et al., 2020).

Gray-Toft and Anderson developed the Nursing Stress Scale (NSS) in 1981, composed of scores and divided into seven diverse and stressful states; mortality (7 scores), disagreements among doctors (5 scores), insufficient training (3 scores), inadequate personnel assistance (3 scores), nurses’ dispute (5 scores), work burden (6 scores), and confusion about intervention (5 scores). More the score, more will be the stress (Hendy et al., 2020). This instrument measures sources and levels of stress experienced by nurses in their work environment. By using this instrument, changes in stress levels can be evaluated, and the effectiveness of the intervention can be determined. 

NSS is appropriate for use in evaluating interventions for nursing burnout by identifying and addressing specific sources of stress, interventions may be more effective in reducing burnout and promoting overall well-being among nurses. Another reason for its use is its specificity for this issue, as it is the initially developed instrument to focus only on nursing stress rather than the common stress of employment (Alharbi & Hasan, 2019).

Construct Analysis

The MBI is a widely used instrument that measures burnout in individuals who work with people, such as healthcare professionals, social workers, and teachers. The MBI assesses three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment (Williamson et al., 2018).

• Emotional exhaustion refers to feelings of being emotionally drained and exhausted from work.
• Depersonalization refers to a negative, cynical, or distant attitude towards patients or clients.
• Personal accomplishment refers to feelings of competence and achievement in one’s work.

The MBI uses a 7-point Likert scale to measure responses, ranging from “never” to “every day”. The MBI has been extensively validated and has demonstrated good psychometric properties, including high internal consistency and test-retest reliability (Lin et al., 2022).

The NSS is a self-report questionnaire that measures stress in nurses. The NSS consists of 34 items that assess four dimensions of stress: stressors inherent in the nursing role, stressors related to relationships with other healthcare professionals, stressors related to the work environment, and stressors related to coping resources (Hendy et al., 2020). The NSS uses a 5-point Likert scale to measure responses, ranging from “strongly disagree” to “strongly agree.” It has been extensively validated by many years of research and can be used to assess the interventions for nursing burnout because of its specificity.

Validity and reliability

Both instruments were validated through various statistical analyses, including factor analysis, Cronbach’s alpha coefficient, and test-retest reliability (Mert et al., 2020) (Todorovic et al., 2021). These analyses were conducted to assess the consistency, stability, and validity of the measures. The MBI and NSS have been used extensively in research and practice, and their psychometric properties have been demonstrated in numerous studies. Both instruments have been translated into multiple languages and are used globally to assess burnout and stress in healthcare professionals including nurses.

Credible Resources and Their Outcomes 

After an in-depth study of the literature on the MBI and NSS application, the following studies can be chosen as the best, evidence-based and credible literature, which can be helpful for nurses for utilization of these tools. Also, different keywords were used to find adequate resources on academic databases including CINAHL, PubMed, Cochrane and others to find relevant data and information. 

Erwan, F., Iqbal, M., Hasanuddin, I., Zuhri, S., & Maydini, C. M. (2020). Burnout syndrome analysis among hospital nurses using Maslach Burnout Inventory – Human Service Survey (MBI-HSS): A case study. IOP Conference Series: Materials Science and Engineering, 931, 012025. https://doi.org/10.1088/1757-899x/931/1/012025. 

This article presents a case study conducted to analyze burnout syndrome among hospital nurses using the combination of Maslach Burnout Inventory – Human Service Survey (MBI-HSS). The study aimed to examine the levels of burnout among nurses and identify the factors that contribute to burnout in the workplace. The study involved 100 nurses from three public hospitals who completed the MBI-HSS questionnaire.

NURS FPX 8030 Assessment 4 Methods and Measurement

The researchers found that most nurses in the study experienced elevated levels of emotional exhaustion, which is a significant indicator of burnout. In contrast, a lower percentage of nurses experienced high levels of depersonalization, which suggests that nurses in the study did not feel distant or cynical toward their patients. The authors also found that personal accomplishment, which refers to feelings of competence and achievement in one’s work, was low among the nurses, indicating a lack of professional fulfilment. Most of the nurses who experienced burnout were less than 20 years old (Erwan et al., 2020).

Hendy, A., Abozeid, A., Sallam, G., Abboud Abdel Fattah, H., & Ahmed Abdelkader Reshia, F. (2020). Predictive factors affecting stress among nurses providing care at COVID‐19 isolation hospitals at Egypt. Nursing Open. https://doi.org/10.1002/nop2.652. 

This article examines the factors that predict stress among nurses providing care to COVID-19 patients in isolation hospitals in Egypt. The study identified the demographic and work-related factors that contribute to stress among nurses during the pandemic. A cross-sectional study was conducted, and data were collected using an electronic survey distributed to 524 nurses working in five isolation hospitals in Egypt.

Based on NSS, the results of this study showed that the highest score of NSS was insufficient training, work burden and reduced assistance. The minimal score was for disputes among nurses and with doctors. Almost 50% of the surveyed nurses have normal stress levels while more than 25% of them had high stress level. The authors found that factors such as age, years of experience, and education level were not significant predictors of stress among nurses. However, work-related factors such as inadequate resources, lack of personal protective equipment, and inadequate training on infection prevention and control were significant predictors of stress (Hendy et al., 2020).

The Rationale for Credible Resources

The MBI and NSS tools were used for the present issue because these are the most validated and widely used tools specifically for the nursing burnout issue. To determine the use of MBI and NSS in the studies with similar objectives to our PICOT analysis or present issue (resolving nursing burnout), nurses should do in-depth study of literature. Many peer-reviewed journals like PubMed, CINAHL, Nursing Open and some hospital guidelines can be searched for similar studies. It is important to search some other tools as well for better understanding like the Copenhagen Burnout Inventory (CBI), Oldenburg Burnout Inventory (OLBI), Nurse Stress Index (NSI), Perceived Stress Scale (PSS), and Professional Quality of Life Scale (ProQOL). A combination of two or more tools can help in enhanced assessment of burnout interventions. A recent study compared the CBI and OLBI to the widely used MBI among a subset of doctors and CBI was confirmed as an effective alternative for MBI (Ogunsuji et al., 2022).

The rationale to choose the literature is that: Consulting to such informative and credible literature can help the nurses to use different tools, parameters or their combination, compare these tools and assess their reliability. This will significantly help them to assess interventions for reducing burnout and stress among nurses.

Similarities

Like the project in this course, some other studies have used one or more of assessment instruments to assess burnout in nursing and evaluate the effectiveness of interventions. Many studies use similar interventions such as mentorship, compassion, and counseling etc., to solve the issue of burnout. A recent study used the follow-up counseling as intervention for burnout right after the nurse’s face patient’s aggression (Vincent-Höper et al., 2020). Another recent study used compassion and sympathy towards nurses as an intervention for same case (Hofmeyer et al., 2020). Some studies have used similar statistical analyses to analyze and interpret the data collected from these instruments.

Differences

Several studies used different instruments and parameters to assess burnout in nursing, such as the PSS, CBI, or ProQOL. A recent study used the Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS) and Safety Attitudes Questionnaire (SAQ) for the examination of burnout and related factors among different healthcare workers (Tan et al., 2020). The populations, demographics and sample sizes differ across various studies, which could impact the generalizability of the findings. Some studies assess different aspects of burnout, such as emotional exhaustion, depersonalization, or reduced personal accomplishment, while the project in this course is focused generally on burnout and stress in nurses.

Conclusion

To assess the risk and prevalence of burnout and stress in nurses, tools like the Maslach Burnout Inventory (MBI) and Nursing Stress Score (NSS) can be used effectively. It is important to consider the validation of these tools before using them. Also, the sample size, demographics, population, and quality of parameters should be utilized in a pragmatic setting. Although there is relevant literature available, but still there is a need for further studies to determine the interventions for nursing burnout and the application of various instruments to assess the proposed interventions.

References

Alharbi, S., & Hasan, A. A. (2019). Occupational stress, coping strategies, and quality of life among nurses in general and psychiatric setting in Jeddah city—KSA. Open Journal of Psychiatry, 09(02), 124–137. https://doi.org/10.4236/ojpsych.2019.92010 

Erwan, F., Iqbal, M., Hasanuddin, I., Zuhri, S., & Maydini, C. M. (2020). Burnout syndrome analysis among hospital nurses using Maslach Burnout Inventory – Human Service Survey (MBI-HSS): A case study. IOP Conference Series: Materials Science and Engineering, 931, 012025. https://doi.org/10.1088/1757-899x/931/1/012025 

Hendy, A., Abozeid, A., Sallam, G., Abboud Abdel Fattah, H., & Ahmed Abdelkader Reshia, F. (2020). Predictive factors affecting stress among nurses providing care at COVID‐19 isolation hospitals at Egypt. Nursing Open. https://doi.org/10.1002/nop2.652 

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the COVID-19 pandemic and beyond? Nurse Education Today, 104502. https://doi.org/10.1016/j.nedt.2020.104502 

Lin, C.-Y., Alimoradi, Z., Griffiths, M. D., & Pakpour, A. H. (2022). Psychometric properties of the Maslach Burnout Inventory for medical personnel (MBI-HSS-MP). Heliyon, 8(2), e08868. https://doi.org/10.1016/j.heliyon.2022.e08868 

Mert, S., Aydin Sayilan, A., & Baydemir, C. (2020). Nurse Stress Scale (NSS): Reliability and validity of the Turkish version. Perspectives in Psychiatric Care, 57(2). https://doi.org/10.1111/ppc.12606 

Ogunsuji, O., Ogundipe, H., Adebayo, O., Oladehin, T., Oiwoh, S., Obafemi, O., Soneye, O., Agaja, O., Uyilawa, O., Efuntoye, O., Alatishe, T., Williams, A., Ilesanmi, O., & Atilola, O. (2022). Internal reliability and validity of Copenhagen Burnout Inventory and Oldenburg Burnout Inventory compared with Maslach Burnout Inventory among Nigerian resident doctors: A pilot study. Dubai Medical Journal, 5(2), 1–7. https://doi.org/10.1159/000521376 

NURS FPX 8030 Assessment 4 Methods and Measurement

Tan, B. YQ., Abhiram, K., Lim, L. JH., Tan, M., Chua, Y. X., Tan, L., Sia, C. H., Denning, M., Goh, E. T., Purkayastha, S., Kinross, J., Sim, K., Chan, Y. H., & Ooi, S. (2020). Burnout and associated factors amongst healthcare workers in Singapore during the COVID-19 pandemic. Journal of the American Medical Directors Association, 21(12). https://doi.org/10.1016/j.jamda.2020.09.035 

Todorovic, J., Terzic-Supic, Z., Divjak, J., Stamenkovic, Z., Mandic-Rajcevic, S., Kocic, S., Ukropina, S., Markovic, R., Radulovic, O., Arnaut, A., Piperac, P., Mirkovic, M., & Nesic, D. (2021). Validation of the study burnout inventory and the Copenhagen Burnout Inventory for the use among medical students. International Journal of Occupational Medicine and Environmental Health. https://doi.org/10.13075/ijomeh.1896.01726 

Vincent-Höper, S., Stein, M., Nienhaus, A., & Schablon, A. (2020). Workplace aggression and burnout in nursing—The moderating role of follow-up counseling. International Journal of Environmental Research and Public Health, 17(9), 3152. https://doi.org/10.3390/ijerph17093152 

Williamson, K., Lank, P. M., Cheema, N., Hartman, N., & Lovell, E. O. (2018). Comparing the Maslach Burnout Inventory to other well-being instruments in emergency medicine residents. Journal of Graduate Medical Education, 10(5), 532–536. https://doi.org/10.4300/jgme-d-18-00155.1 

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