Background: The COVID-19 pandemic and the increased workload and stress associated with the disease prevalence have posed a high risk of burnout to nurses. The effects of the workplace and environmental factors on resilience and burnout among nursing professionals have not been investigated in Iran.
Objective: Present study aimed to assess a model linking quality of work-life to the resilience and various dimensions of burnout among Iranian nursing professionals based on the health service workplace environmental resilience model.
Methods: This was a cross-sectional study performed on 202 Iranian nurses employed in three educational hospitals. Maslach burnout inventory, Brooks’ quality of nursing work-life survey, and an abbreviated version of the Connor-Davidson resilience scale were used to collect data. The correlation between the study variables was assessed by conducting path analysis in AMOS 22.
Results: The final model demonstrated adequate fit. The quality of working life indirectly affected burnout via a direct impact on nursing professionals’ resilience (p <0.001, β = 0.39). In addition, resilience had negative, significant effects on all the dimensions of job burnout. The quality of work-life also had negative and significant effects on emotional exhaustion (p <0.001, β = -0.38) and reduced personal accomplishment (p <0.001, β = - 0.38).
Conclusion: Resilience and quality of work-life are protective variables against burnout in nursing professionals. Nursing managers can increase resilience and decrease burnout among nursing professionals by adopting policies that can improve the quality of work life.
Copyright (c) 2021 Hosein Zahednezhad, Armin Zareiyan, Sanaz Zargar Balaye Jame
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Article MetricsAbstract views: 1547 | PDF views: 779
Afshari, D., Nourollahi-Darabad, M., & Chinisaz, N. (2021). Psychosocial factors associated with resilience among Iranian nurses during COVID-19 outbreak. Frontiers in Public Health, 1092. https://doi.org/10.3389/fpubh.2021.714971
Ambani, Z., Kutney‐Lee, A., & Lake, E. T. (2020). The nursing practice environment and nurse job outcomes: A path analysis of survey data. Journal of Clinical Nursing, 29(13-14), 2602-2614. https://doi.org/10.1111/jocn.15283
Ariapooran, S., Ahadi, B., & Khezeli, M. (2021). Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Archives of Psychiatric Nursing. https://doi.org/10.1016/j.apnu.2021.05.005
Azarrang, S. H., Yaghmaei, F., & Shiri, M. (2013). Correlation dimensions of quality of work life of nurses and demographic characteristics. Iranian Journal of Nursing Research, 7(27), 18-24.
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588-606. https://doi.org/10.1037/0033-2909.88.3.588
Brooks, B. A., & Anderson, M. A. (2005). Defining quality of nursing work life. Nursing Economics, 23(6), 319-326.
Brooks, B. A., Storfjell, J., Omoike, O., Ohlson, S., Stemler, I., Shaver, J., & Brown, A. (2007). Assessing the quality of nursing work life. Nursing Administration Quarterly, 31(2), 152-157. https://doi.org/10.1097/01.NAQ.0000264864.94958.8e
Cam, O., & Büyükbayram, A. (2017). Nurses' resilience and effective factors. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 8(2), 118-126. https://doi.org/10.14744/phd.2017.75436
Campbell Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the connor–davidson resilience scale (CD‐RISC): Validation of a 10‐item measure of resilience. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 20(6), 1019-1028. https://doi.org/10.1002/jts.20271
Connor, K. M. (2006). Assessment of resilience in the aftermath of trauma. Journal of Clinical Psychiatry, 67(2), 46-49.
Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and Anxiety, 18(2), 76-82. https://doi.org/10.1002/da.10113
Dehghan Nayeri, N., Salehi, T., & Ali Asadi Noghabi, A. (2011). Quality of work life and productivity among Iranian nurses. Contemporary Nurse, 39(1), 106-118. https://doi.org/10.5172/conu.2011.39.1.106
Duarte, J., & Pinto-Gouveia, J. (2017). The role of psychological factors in oncology nurses' burnout and compassion fatigue symptoms. European Journal of Oncology Nursing, 28, 114-121. https://doi.org/10.1016/j.ejon.2017.04.002
Ghimbulut, O., & Opre, A. (2013). Assessing resilience using mixed methods: Youth resilience measure. Procedia-Social and Behavioral Sciences, 78, 310-314. https://doi.org/10.1016/j.sbspro.2013.04.301
Giusti, E. M., Pedroli, E., D'Aniello, G. E., Badiale, C. S., Pietrabissa, G., Manna, C., . . . Molinari, E. (2020). The psychological impact of the COVID-19 outbreak on health professionals: A cross-sectional study. Frontiers in Psychology, 11. https://dx.doi.org/10.3389%2Ffpsyg.2020.01684
Hemsworth, D., Baregheh, A., Khorakian, A., Muterera, J., Plough, J. F., Garcia-Rivera, B. R., . . . Aoun, S. (2020). The resource-based reflective risk assessment model for understanding the quality of work life of nurses. Nursing Outlook, 68(2), 194-206. https://doi.org/10.1016/j.outlook.2019.10.006
Hietapakka, L., Elovainio, M., Heponiemi, T., Presseau, J., Eccles, M., Aalto, A.-M., . . . Sinervo, T. (2013). Do nurses who work in a fair organization sleep and perform better and why? Testing potential psychosocial mediators of organizational justice. Journal of Occupational Health Psychology, 18(4), 481. https://psycnet.apa.org/doi/10.1037/a0033990
Ho, C. S. H., Chee, C. Y., & Ho, R. C. (2020). Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Annals of the Academy of Medicine, Singapore, 49(1), 1-3. https://doi.org/10.47102/annals-acadmedsg.202043
Jo, S., Kurt, S., Bennett, J. A., Mayer, K., Pituch, K. A., Simpson, V., . . . Ozluk, B. (2021). Nurses' resilience in the face of coronavirus (COVID‐19): An international view. Nursing & Health Sciences, 23(3), 646-657. https://doi.org/10.1111/nhs.12863
Jose, S., Dhandapani, M., & Cyriac, M. C. (2020). Burnout and resilience among frontline nurses during COVID-19 pandemic: A cross-sectional study in the emergency department of a tertiary care center, North India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(11), 1081-1088. https://dx.doi.org/10.5005%2Fjp-journals-10071-23667
Kakemam, E., Chegini, Z., Rouhi, A., Ahmadi, F., & Majidi, S. (2021). Burnout and its relationship to self‐reported quality of patient care and adverse events during COVID‐19: A cross‐sectional online survey among nurses. Journal of Nursing Management, 29(7), 1974– 1982. https://doi.org/10.1111/jonm.13359
Kelbiso, L., Belay, A., & Woldie, M. (2017). Determinants of quality of work life among nurses working in Hawassa town public health facilities, South Ethiopia: A cross-sectional study. Nursing Research and Practice, 2017, 5181676. https://doi.org/10.1155/2017/5181676
Keyhani, M., Taghvaei, D., Rajabi, A., & Amirpour, B. (2015). Internal consistency and confirmatory factor analysis of the Connor-Davidson Resilience Scale (CD-RISC) among nursing female. Iranian Journal of Medical Education, 14(10), 857-865.
Kline, R. B. (2015). Principles and practice of structural equation modeling. New York: Guilford publications.
Lake, E. T. (2002). Development of the practice environment scale of the nursing work index. Research in Nursing & Health, 25(3), 176-188. https://doi.org/10.1002/nur.10032
Laksmita, O. D., Chung, M. H., Liao, Y. M., Haase, J. E., & Chang, P. C. (2020). Predictors of resilience among adolescent disaster survivors: A path analysis. Journal of Advanced Nursing, 76(8), 2060-2071. https://doi.org/10.1111/jan.14396
Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. JONA: The Journal of Nursing Administration, 36(5), 259-267. https://doi.org/10.1097/00005110-200605000-00019
Leners, C., Sowers, R., Quinn Griffin, M. T., & Fitzpatrick, J. J. (2014). Resilience and professional quality of life among military healthcare providers. Issues in Mental Health Nursing, 35(7), 497-502. https://doi.org/10.3109/01612840.2014.887164
Malach-Pines, A. (2000). Nurses' burnout: An existential psychodynamic perspective. Journal of Psychosocial Nursing, 38(2), 23-31. https://doi.org/10.3928/0279-3695-20000201-06
Marzilli, C. (2021). A year later: Life after the Year of the Nurse. Belitung Nursing Journal, 7(2), 59-61. https://doi.org/10.33546/bnj.1509
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99-113. https://doi.org/10.1002/job.4030020205
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52(1), 397-422. https://doi.org/10.1146/annurev.psych.52.1.397
Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2(4), 425-444. https://doi.org/10.1017/S0954579400005812
Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. International Journal of Nursing Studies, 49(3), 292-299. https://doi.org/10.1016/j.ijnurstu.2011.09.015
Moalemi, S., Kavosi, Z., Beygi, N., Deghan, A., Karimi, A., & Parvizi, M. M. (2018). Evaluation of the Persian version of Maslach Burnout Inventory-Human Services Survey among Iranian nurses: Validity and reliability. Galen Medical Journal, 7, e995. https://dx.doi.org/10.22086%2Fgmj.v0i0.995
Monsalve-Reyes, C. S., San Luis-Costas, C., Gómez-Urquiza, J. L., Albendín-García, L., Aguayo, R., & Cañadas-De la Fuente, G. A. (2018). Burnout syndrome and its prevalence in primary care nursing: A systematic review and meta-analysis. BMC Family Practice, 19(1), 1-7. https://doi.org/10.1186/s12875-018-0748-z
Nikeghbal, K., Kouhnavard, B., Shabani, A., & Zamanian, Z. (2021). Covid-19 effects on the mental workload and quality of work life in Iranian nurses. Annals of Global Health, 87(1), 79. https://dx.doi.org/10.5334%2Faogh.3386
Permarupan, P. Y., Al Mamun, A., Samy, N. K., Saufi, R. A., & Hayat, N. (2020). Predicting nurses burnout through quality of work life and psychological empowerment: A study towards sustainable healthcare services in Malaysia. Sustainability, 12(1), 388. https://doi.org/10.3390/su12010388
Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420. https://doi.org/10.4037/ajcc2015291
Straub, D. W. (1989). Validating instruments in MIS research. MIS quarterly, 147-169. https://doi.org/10.2307/248922
Turner, S. B. (2014). The resilient nurse: An emerging concept. Nurse Leader, 12(6), 71-90. https://doi.org/10.1016/j.mnl.2014.03.013
Vagharseyyedin, S. A., Vanaki, Z., & Mohammadi, E. (2011). The nature nursing quality of work life: An integrative review of literature. Western Journal of Nursing Research, 33(6), 786-804. https://doi.org/10.1177%2F0193945910378855
WHO. (2018). Nursing and midwifery personnel (per 10 000 population). Retrieved from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/nursing-and-midwifery-personnel-(per-10-000-population)
World Health Organization [WHO]. (2021). WHO Coronavirus (COVID-19) dashboard. Retrieved from https://covid19.who.int/region/emro/country/ir
Yildirim, M., & Solmaz, F. (2020). COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. Death Studies, 1-9. https://doi.org/10.1080/07481187.2020.1818885
Zahednezhad, H., Gheshlagh, R. G., & Afshar, P. F. (2021). Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study. BMC Nursing, 20(1), 1-7. https://doi.org/10.1186/s12912-021-00662-8
Zhang, X., Jiang, X., Ni, P., Li, H., Li, C., Zhou, Q., . . . Cao, J. (2021). Association between resilience and burnout of front‐line nurses at the peak of the COVID‐19 pandemic: Positive and negative affect as mediators in Wuhan. International Journal of Mental Health Nursing, 30, 939-954. https://doi.org/10.1111/inm.12847