A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment

Ru-Wen LIAO ； Mei-Ling YEH ； Kuan-Chia LIN ； Kwua-Yun WANG

《The Journal of Nursing Research》 28卷2期 (2020/04) Pp. 1-9-008

https://doi.org/10.1097/jnr.0000000000000348

摘要

Background: Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity. Purpose: This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals. Methods: A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index- Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data. Results: On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (β = 0.608, p ＜ .001) and depersonalization (β = 2.439, p ＜ .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (β = −0.250, p ＜ .001), depersonalization (β = −1.587, p ＜ .001), and personal accomplishment (β = 4.126, p ＜ .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (β = 0.111, p ＜ .01; β = 0.583, p ＜ .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p ＞ .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p ＜ .001). Conclusions/Implications for Practice: The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.

關鍵字

occupational burnout ； job-induced stress ； self-concept ； practice environment ； nurse

參考文獻

Chao, W. C., Yuan, C. Y., Wang, M. H., & Hsieh, P. C. (2008). A study of perceived nursing work environment among nurses: An example of regional teaching hospitals in Taipei County. Journal of Oriental Institute of Technology, 28_S, 105-116. https://doi.org/10.30167/JOIT.200812.0012 (Original work published in Chinese)

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., … Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904–921. https://doi.org/10.1111/j.1475-6773.2010.01114.x

Angel, E., Craven, R., & Denson, N. (2012). The nurses' self-concept instrument (NSCI): Assessment of psychometric properties for Australian domestic and international student nurses. International Journal of Nursing Studies, 49(7), 880-886. https://doi.org/10.1016/j.ijnurstu.2012.01.016

Bogaert, P. V., Clarke, S., Roelant, E., Meulemans, H., & Heyning, P. V. (2010). Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: A multilevel modelling approach. Journal of Clinical Nursing, 19(11–12), 1664–1674. https://doi.org/10.1111/j.1365-2702.2009.03128.x

Chae, S. N., Ko, I. S., Kim, I. S., & Yoon, K. S. (2015). Effect of perception of career ladder system on job satisfaction, intention to leave among perioperative nurses. Journal of Korean Academy of Nursing Administration, 21(3), 233–242. https://doi.org/10.11111/jkana.2015.21.3.233