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Critical care staff wellbeing: A new paradigm for understanding burnout

Published:November 24, 2022DOI:https://doi.org/10.1016/j.aucc.2022.10.010

      Abstract

      Background

      The wellbeing of paediatric intensive care unit (PICU) staff members influences their engagement with work and the quality of care they provide to patients. Baseline burnout measures in research provide inconclusive evidence of the determinants of burnout and how to target interventions to promote staff wellbeing.

      Objectives

      The objectives of this study were to determine the prevalence of burnout using the Maslach Burnout Inventory (MBI) burnout-engagement workplace profiles in a sample of Australian PICU staff and investigate associations between demographic characteristics, meaningful work, satisfaction with life, and psychological distress on burnout.

      Methods

      A cross-sectional survey was administered to a multidisciplinary sample of PICU staff (target n = 464) from three tertiary paediatric hospitals in Australia. The survey tool was comprised of the MBI, Work and Meaning Inventory, Satisfaction with Life Scale, Kessler Psychological Distress Scale, and demographic questions. Hierarchical multiple regressions examined the relationships between burnout and these variables of interest.

      Results

      A sample of 258 participants (56%) completed the survey. For most respondents, burnout was scored as a low to moderate risk, with over half the participants scoring low risk for emotional exhaustion (EE) (56%) and depersonalisation (DP) (54%). Personal accomplishment (PA) was more evenly distributed (range of burnout risk: low, 32%; moderate, 32%; high, 36%). MBI scores were classified using the burnout-engaged workplace profile system, identifying low levels of burnout (8% burnout, 3% disengaged, 21% overextended, 29% ineffective, and 39% engaged). Psychological distress significantly increased burnout risk across all three dimensions EE (β = 0.253, p < 0.001), DP  = 0.145, p < 0.05), and PA (β = −0.13, p < 0.05), and being aged between 41 and 55 years was protective of depersonalisation (β = −0.214, p < 0.05).

      Conclusion

      Utilising MBI workplace profiles, this study has built upon the demand for a more comprehensive assessment of burnout. Research that helps improve our understanding of contributory factors to burnout and wellbeing will inform the development of effective interventions that promote wellbeing of staff.

      Keywords

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      References

        • Moynihan K.M.
        • Alexander P.M.A.
        • Schlapbach L.J.
        • Millar J.
        • Jacobe S.
        • Ravindranathan H.
        • et al.
        Epidemiology of childhood death in Australian and New Zealand intensive care units.
        Intensive Care Med. 2019; 45: 1262-1271
        • Wheeler D.S.
        • Dewan M.
        • Maxwell A.
        • Riley C.L.
        • Stalets E.L.
        Staffing and workforce issues in the pediatric intensive care unit.
        Transl Pediatr. 2018; 7: 275-283
        • van Mol M.
        • Kompanje E.
        • Benoit D.
        • Bakker J.
        • Nijkamp M.
        The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: a systematic review.
        PLoS One. 2015; 10
        • Vincent L.
        • Brindley P.G.
        • Highfield J.
        • Innes R.
        • Greig P.
        • Suntharalingam G.
        Burnout Syndrome in UK Intensive Care Unit staff: data from all three Burnout Syndrome domains and across professional groups, genders and ages.
        Journal of the Intensive Care Society. 2019; 20: 363-369
        • Chen S.
        • McMurray A.
        Burnout in intensive care nurses.
        J Nurs Res. 2001; 9: 152-164
        • Kellogg M.B.
        • Knight M.
        • Dowling J.S.
        • Crawford S.
        Secondary traumatic stress in pediatric nurses.
        J Pediatr Nurs. 2018; 43: 97-103
        • Sekol M.A.
        • Kim S.C.
        Job satisfaction, burnout, and stress among pediatric nurses in various specialty units at an acute care hospital.
        J Nurs Educ Pract. 2014; 4: 115
        • Crowe L.
        • Young J.
        • Turner M.J.
        What is the prevalence and risk factors of burnout among pediatric intensive care staff (PICU)? A review.
        Transl Pediatr. 2021; 10: 2825-2835
        • Patel R.S.
        • Bachu R.
        • Adikey A.
        • Malik M.
        • Shah M.
        Factors related to physician burnout and its consequences: a review.
        Behav Sci. 2018; 8
        • West C.P.
        • Dyrbye L.N.
        • Shanafelt T.D.
        Physician burnout: contributors, consequences and solutions.
        J Intern Med. 2018; 283: 516-529
        • Schaufeli W.B.
        Burnout, fatigue, exhaustion: an interdisciplinary perspective on a modern affliction.
        in: Necknna S. Schaffner A. Wagner G. Burnout, fatigue, exhaustion: an interdisciplinary perspective on a modern affliction. 1st ed. Springer-Verlag, Germany2017: 105-127
        • Weigl M.
        • Schneider A.
        • Hoffmann F.
        • Angerer P.
        Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians.
        Eur J Pediatr. 2015; 174: 1237-1246
        • Matsuishi Y.
        • Mathis B.J.
        • Masuzawa Y.
        • Okubo N.
        • Shimojo N.
        • Hoshino H.
        • et al.
        Severity and prevalence of burnout syndrome in paediatric intensive care nurses: a systematic review.
        Intensive Crit Care Nurs. 2021; 67103082
        • Litchfield P.
        • Cooper C.
        • Hancock C.
        • Watt P.
        Work and wellbeing in the 21st century [dagger].
        Int J Environ Res Publ Health. 2016; 13: 1-11
        • Ng E.
        • Fisher A.
        Understanding well-being in multi-levels: a review.
        Health Cult Soc. 2013; 5: 308
        • Bart R.
        • Ishak W.W.
        • Ganjian S.
        • Jaffer K.Y.
        • Abdelmesseh M.
        • Hanna S.
        • et al.
        The assessment and measurement of wellness in the clinical medical setting: a systematic review.
        Innov Clin Neurosci. 2018; 15: 14-23
        • Hewitt D.B.
        • Ellis R.J.
        • Hu Y.-Y.
        • Cheung E.O.
        • Moskowitz J.T.
        • Agarwal G.
        • et al.
        Evaluating the association of multiple burnout definitions and thresholds with prevalence and outcomes.
        JAMA Surg. 2020; 155: 1043-1049
        • Hillert A.
        • Albrecht A.
        • Voderholzer U.
        The burnout phenomenon: a resume after more than 15,000 scientific publications.
        Front Psychiatr. 2020; 11519237
        • Maslach C.
        • Leiter M.P.
        How to measure burnout accurately and ethically.
        Harv Bus Rev. 2021(March); : 7
        • Ryff C.D.
        Psychological well-being revisited: advances in the science and practice of eudaimonia.
        Psychother Psychosom. 2014; 83: 10-28
        • Eckleberry-Hunt J.
        • Kirkpatrick H.
        • Barbera T.
        The problems with burnout research.
        Acad Med. 2018; 93: 367-370
        • Eckleberry-Hunt J.
        • Van Dyke A.
        • Lick D.
        • Tucciarone J.
        Changing the conversation from burnout to wellness: physician well-being in residency training programs.
        J Grad Med Educ. 2009; 1: 225-230
        • Sonnentag S.
        Wellbeing and burnout in the workplace: organizational causes and consequences.
        International Encyclopedia of the Social & Behavioral Sciences. 2015; 25: 537-540
        • Sweileh W.M.
        Research trends and scientific analysis of publications on burnout and compassion fatigue among healthcare providers.
        J Occup Med Toxicol. 2020; 15: 1-23
        • Maslach C.
        • Leiter M.P.
        Understanding burnout: new models.
        in: Cooper C. Quick J.C. The handbook of stress and health newark. John Wiley & Sons, 2017: 36-56
        • Leiter M.P.
        • Maslach C.
        Latent burnout profiles: a new approach to understanding the burnout experience.
        Burnout Research. 2016; 3: 89-100
        • Maslach C.
        • Leiter M.P.
        Understanding the burnout experience: recent research and its implications for psychiatry.
        World Psychiatr. 2016; 15: 103-111
        • National Academies of Sciences E, Medicine
        Taking action against clinician burnout: a systems approach to professional wellbeing.
        National Academies Press, Washington DC2019: 334
        • Steger M.
        • Dik B.J.
        • Duffy R.D.
        Measuring meaningful work: the work and meaning inventory (WAMI).
        J Career Assess. 2012; 20: 322-337
        • Both-Nwabuwe J.M.C.
        • Dijkstra M.T.M.
        • Beersma B.
        Sweeping the floor or putting a man on the moon: how to define and measure meaningful work.
        Front Psychol. 2017; 8: 1658
        • Bayer N.D.
        • Taylor A.
        • Fallon A.
        • Wang H.
        • Santolaya J.L.
        • Bamat T.W.
        • et al.
        Pediatric residents' sense of meaning in their work: is this value related to higher specialty satisfaction and reduced burnout?.
        Acad Pediatr. 2021; 21: 557-563
        • Starmer A.J.
        • Frintner M.P.
        • Freed G.L.
        Work-life balance, burnout, and satisfaction of early career pediatricians.
        Pediatrics. 2016; 137
        • Rodriguez-Rey R.
        • Palacios A.
        • Alonso-Tapia J.
        • Perez E.
        • Alvarez E.
        • Coca A.
        • et al.
        Are pediatric critical personnel satisfied with their lives? Prediction of satisfaction with life from burnout, posttraumatic stress, and posttraumatic growth, and comparison with noncritical pediatric staff.(report)(author abstract).
        Pediatr Crit Care Med. 2019; 20e160
        • Costa D.K.
        • Moss M.
        The cost of caring: emotion, burnout, and psychological distress in critical care clinicians.
        Ann Am Thorac Soc. 2018; 15: 787-790
        • Kleinpell R.
        • Moss M.
        • Good V.S.
        • Gozal D.
        • Sessler C.N.
        The critical nature of addressing burnout prevention: results from the critical care societies Collaborativeʼs national summit and survey on prevention and management of burnout in the ICU.
        Crit Care Med. 2020; 48: 249-253
        • Foglia D.C.
        • Grassley J.S.
        • Zeigler V.L.
        Factors that influence pediatric intensive care unit nurses to leave their jobs.
        CCNQ (Crit Care Nurs Q). 2010; 33: 302-316
        • Maslach C.
        • Jackson S E.
        • Leiter M.P.
        Maslach burnout inventory.
        Manual 4th ed. Mind Garden Inc, California, USA1996
        • Diener E.
        • Emmons R.A.
        • Larsen R.J.
        • Griffin S.
        The satisfaction with life scale.
        J Pers Assess. 1985; 49: 71-75
        • Pavot W.
        • Diener E.
        Review of the satisfaction with life scale.
        in: Diener E. Assessing well-being the collected works of ed diener. Springer, Netherlands2009
        • Diener E.
        • Inglehart R.
        • Tay L.
        Theory and validity of life satisfaction scales.
        Soc Indicat Res. 2013; 112: 497-527
        • Kessler R.C.
        • Andrews G.
        • Colpe L.J.
        • Hiripi E.
        • Mroczek D.K.
        • Normand S.L.T.
        • et al.
        Short screening scales to monitor population prevalences and trends in non-specific psychological distress.
        Psychol Med. 2002; 32: 959-976
        • Adams M.A.
        • Brazel M.
        • Thomson R.
        • Lake H.
        The mental health of Australian medical practitioners during Covid-19.
        Australas Psychiatr. 2021; 10398562211010807
        • Batterham P.J.
        • Sunderland M.
        • Slade T.
        • Calear A.L.
        • Carragher N.
        Assessing distress in the community: psychometric properties and crosswalk comparison of eight measures of psychological distress.
        Psychol Med. 2018; 48: 1316-1324
        • Sampasa-Kanyinga H.
        • Zamorski M.A.
        • Colman I.
        The psychometric properties of the 10-item kessler psychological distress scale (K10) in canadian military personnel.
        PLoS One. 2018; 13: e0196562-e
        • Wu F.
        • Ireland M.
        • Hafekost K.
        • Lawrence D.
        National mental health survey of doctors and medical students.
        Beyond Blue, 2013 October (2013)
        • Butterworth P.
        • Watson N.
        • Wooden M.
        Trends in the prevalence of psychological distress over time: comparing results from longitudinal and repeated cross-sectional surveys.
        Front Psychiatr. 2020; 11595696
        • Mind Garden I.
        A message from the Maslach burnout inventory authors [blog].
        Mind Garden, Inc, CA, USA2019 (updated 19.03.2019. Workplace Profiles])
        • West C.P.
        • Dyrbye L.N.
        • Erwin P.J.
        • Shanafelt T.D.
        Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.
        Lancet. 2016; 388: 2272-2281
        • Buckley L.
        • Christian M.
        • Gaiteiro R.
        • Pasrshuram C.
        • Watson S.
        • Dryden-Palmer C.K.
        The relationship between pediatric critical care nurse burnout and attitudes about engaging with patients and families.
        The Canadian Journal of Critical Care Nursing. 2019; 30: 22-28
        • Lin T.C.
        • Lin H.S.
        • Cheng S.F.
        • Wu L.M.
        • Ou-Yang M.C.
        Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.
        J Clin Nurs. 2016; 25: 1120-1130
        • Rehder K.J.
        • Cheifetz I.M.
        • Markovitz B.P.
        • Turner D.A.
        Pediatric Acute Lung I, Sepsis Investigators N. Survey of in-house coverage by pediatric intensivists: characterization of 24/7 in-hospital pediatric critical care faculty coverage.
        Pediatr Crit Care Med : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2014; 15: 97
        • Gribben J.L.
        • Kase S.M.
        • Waldman E.D.
        • Weintraub A.S.
        A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric critical care physicians in the United States∗.(Report)(Author abstract).
        Pediatr Crit Care Med. 2019; 20: 213
        • OECD
        Health at a glance 2019. OECD.
        OECD Library, 2019
        • Heinemann L.V.
        • Heinemann T.
        Burnout research: emergence and scientific investigation of a contested diagnosis.
        Sage Open. 2017; 7
        • Meinershagen K.
        Impact of meaningful recognition on work environment perception of critical care nurses.
        ProQuest Dissertations Publishing, 2020
        • Buckley L.
        • Berta W.
        • Cleverley K.
        • Medeiros C.
        • Widger K.
        What is known about paediatric nurse burnout: a scoping review.
        Hum Resour Health. 2020; 18: 9
        • Radabaugh C.L.
        • Ruch-Ross H.S.
        • Riley C.L.
        • Stockwell J.A.
        • Conway E.E.
        • Mink R.B.
        • et al.
        Practice patterns in pediatric critical care medicine: results of a workforce survey.
        Pediatr Crit Care Med. 2015; 1
        • Kok N.
        • Van Gurp J.
        • van der Hoeven J.G.
        • Fuchs M.
        • Hoedemaekers C.
        • Zegers M.
        Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study.
        BMJ quality & safety, 2021 (bmjqs-2020-012239)
        • Mariscalco M.M.
        Are we "burned out" or just "Burned"…on burnout research? Pediatric critical care medicine.
        a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2019; 20: 290
        • Statistics AABo
        National study of mental health and wellbeing: abs.
        2022 ([cited 2021. Available from:)
        • Dodge R.
        • Daly A.
        • Huyton J.
        • Sanders L.
        The challenge of defining wellbeing.
        International Journal of Wellbeing. 2012; 2: 222-235
        • Chari R.
        • Chang C.-C.
        • Sauter S.L.
        • Petrun Sayers E.L.
        • Cerully J.L.
        • Schulte P.
        • et al.
        Expanding the paradigm of occupational safety and health: a new framework for worker well-being.
        J Occup Environ Med. 2018; 60: 589-593
        • Beckett K.
        Professional wellbeing and caring: exploring a complex relationship.
        Br J Nurs. 2013; 22: 1118-1124