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Nursing is a profession that over the years has developed a multitude of theories to help define different aspects within the concepts of nursing. A concept analysis is a useful tool in theory development as it is a way to clearly “define or distinguish concepts and provides a universal language for understanding within a discipline” (McCarthy and Fitzpatrick, 2016, p.4). The nursing concept that I have selected for this concept analysis is burnout. Burnout is prevalent in all nursing specialties and can have detrimental effects not only on the nurse who experiences burnout but may negatively impact patient care. The nursing theory that I have selected that addresses this concept of burnout is the Self Efficacy Theory by Alberta Bandura. This paper will address using Walker and Avant’s eleven steps of concept analysis I will address burnout and how it relates to Bandura’s theory of Self Efficacy. This concept analysis will define burnout supported with a literature review, it will also provide defining attributes, antecedents and consequences of burnout, as well as provide empirical referents, construct cases, and theoretical applications of the concept.
Definition and Explanation of Burnout
Burnout may be defined in different ways. Webster dictionary defines burnout as “a state of exhaustion that may be physical, emotional, or lack of motivation usually brought on by prolonged stress or frustration” (Merrium-Webster, 2018). Burnout may also be defined as “a psychological state characterized by exhaustion, both physical and mental, and results in people distancing themselves from their professions” (Njim et al., 2018). Nurses may experience burnout due to different factors. Some of the most common causes of burnout include “understaffed departments which lead to nurses being overworked, job frustration, the conflict between co-workers, poor work/life balance, increased stress levels, reduced personal accomplishment, and family/emotional issues” (Preventing Nurse Burnout, 2017). Due to the different influences of burnout, not all causes of burnout are the same and those who experience burnout may experience similar signs or symptoms. Some indications of burnout could be personality changes, apathy at work, expressions of anger, exhaustion (both mental/physical), lack of empathy, and frequent missed days at work.
Literature Review
The first article reviewed was, “Burnout in Transplant Nurses” by Jesse, Abouljoud, Hogan, and Eshelman (2015). In this article, the authors used a qualitative study to report the prevalence of depersonalization, emotional exhaustion, and reduced personal accomplishment in transplant nurses, while also examining how different factors such as psychological job demands and professional characteristics may contribute to burnout (Jesse, Abouljoud, Hogan, and Eshelman, 2015). This study shows that “the frequency of difficult patient interactions had an impact on the emotional exhaustion and depersonalization of the nurse, as well as the importance of how the nurse perceived that encounter” (Jesse et al., 2015). Overall this study showed that burnout for nurses may be influenced by different factors such as their specialty or personal perceptions of interactions.
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The second article to be reviewed was, “Burnout and Resilience Among Nurses Practicing in High-Intensity Settings” by Hylton Rushton, Batcheller, Schroeder, and Donohue (2015). The article identified that burnout was “associated with adverse health outcomes, increased nurse turnover, and decreased patient satisfaction” (Hylton Rushton, Batcheller, Schroeder, and Donohue, 2015). This article examined specialty areas who are at a high risk for burnout (pediatrics, critical care, oncology) and to identify the needs to create a healthier work environment. This study used the Maslach Burnout questionnaire. The results showed that “high levels of emotional exhaustion were correlated with low levels of personal accomplishment, and high levels of depersonalization” (Hylton Rushton et al., 2015). and found that “nurses with spiritual wellbeing, resilience, hope, and higher scores on meaning in patient care were more protected against burnout” (Hylton Rushton et al., 2015).
The third article to be reviewed is “Relationship Among Nurses Role Overload, Burnout and Managerial Coping Strategies at Intensive Care Units” by Mohamed (2016). The research study in this article was designed to examine burnout and coping strategies in an intensive care unit at Assiut University Hospital. This study utilized the Role Overload questionnaire by Harris and Bladen, the Managerial Coping Strategies Questionnaire, and the Burnout questionnaire by Maslach. The results of this study indicated that “the nurses working in this ICU experienced lower levels of personal accomplishment and higher levels of stress which resulted in higher levels of burnout, resulting in the nurses needing to increase the use of coping strategies” (Mohamed, 2016).
The fourth article to be reviewed is “Personal Determinants of Nurses’ Burnout in End of Life Care” by Gama, Barbosa, and Vieira (2014). This article looked at nurses who provide terminal and palliative care stress levels and influencing factors for these stress levels with a focus on personal variables that are present. Maslach’s Burnout questionnaire was utilized in this study, along with the sociodemographic and experiential questionnaire, the Adult Attachment Scale, and the Purpose and Meaning in Life test. Due to the comparative nature of the research analysis, it was found that “the palliative care units had significantly lower scores in depersonalization and emotional exhaustion, while a higher score in personal accomplishments” (Gama, Barbosa, and Vierira, 2014). This was thought to be influenced by the personal choice of the unit and by feeling that they had a meaningful purpose in helping/caring for those specific patients.
The next article to be examined is the “Historical Review in Understanding Burnout, Professional Compassion Fatigue, and Secondary Traumatic Stress Disorder from a Hospice and Palliative Nursing Perspective” by Melvin (2015). This article is a literature review that looks at the causes and effects of burnout, professional compassion fatigue, and secondary traumatic stress disorder in palliative/hospice nurses, as well as recommendations for coping strategies to prevent these occurrences. Melvin (2015) stated that “two drivers of burnout included excessive workloads and personal conflict” (p.67). The article also recommended that while techniques such as meditation, mindfulness, and self-reflection were important, it was necessary for the nurse to be assertive and to express personal needs and values (Melvin, 2015).
The last article to be reviewed is “The Impact of Burnout on Self‐efficacy, Outcome Expectations, Career Interest, and Nurse Turnover” by Chang, Friesner, Chu, Huang, Liao, and Teng (2018). This article examines how burnout can influence self-efficacy, career interest in the nursing profession, and the expectation of outcomes in a medical center in northern Taiwan. The authors of this article used a research study that involved Maslach’s Burnout questionnaire and they performed a cross-sectional study. Prior to the study, they hypothesized that “self-efficiency was related to career interest and this could be impacted by burnout” (Chang et al., 2018). The study concluded that “burnout influences self-efficiency and outcome expectations” (Chang et al., 2018).
Defining Attributes
Three attributes of the concept are fatigue, cynicism, and overwhelmed. One of the defining aspects of burnout is the exhaustion/fatigue that is described by those who experience burnout. This may have different causes whether it be from physical causes such as being overworked to mental fatigue from the stress that is experienced at work. Cynicism is the negative view that those who are experiencing burnout may express. Cynicism is the “depersonalization that those experiencing burnout utilizes to put distance between themselves and their job” (Melvin, 2015). Experiencing the feeling of being ‘overwhelmed’ in relation to burnout is the result of hopelessness they may feel at work. This can be a direct result from a lack of personal accomplishments in the profession and the constant stress that the person may be under.
Antecedent and Consequence
One antecedent to burnout is experiencing a demanding unit/area of work while being short staffed, resulting in increased stress levels, decreased time to recover, and lack of personal achievement in both personal/work life. One consequence of burnout is that patient outcomes may be poor or negatively impacted due to an unsafe environment. Studies show that those who suffer burnout “may have a lapse in memory, impaired cognitive functions, and diminished vigilance” (Lyndon, 2016). For nurses who work in high stress and fast paced areas such as emergency departments or intensive care units, cognitive impairments may lead to loss of life for patients and high cost for hospital administrations.
Empirical Referents
Two empirical referents to measure/identify burnout are Maslach Burnout Inventory and the Copenhagen Burnout Inventory. The Maslach Burnout Inventory is a questionnaire used to assess burnout in various occupations and in various languages. This assessment is a “sixteen-item scale rated on a five-point Likert scale, that incorporates burnout into three categories (emotional exhaustion, cynicism, and professional personal efficacy)” (Phillips-Hall, Rodriguez, and Galbraith, 2017). The Copenhagen Burnout Inventory assessment measures burnout “in three domains, personal, work, and patient-related and was created to address limitations found in the Maslach Burnout Inventory assessment” (Lapa et al., 2018). These are the two most prevalent questionnaires to assess burnout.
Construct Cases
Burnout is the state when nurses may feel an extreme state of exhaustion/fatigue, lose interest in their job, lose their motivation, become overwhelmed, and try to distance themselves from their professions. An example of a Model Case is a new nurse begins working in a fast-paced, busy emergency department. After completing a limited orientation period, the new nurse is required to work extra shifts due to the understaffed department, which continues for the next year. The nurse is met with many unfavorable patient and family encounters, often struggle with the demands of the patient load, and has limited time at home with family and friends. The nurse also experiences conflict with coworkers.
The nurse feels tired all the time, they feel undervalued, underappreciated, and questions whether they made the right choice in choosing to go into the nursing profession. The nurse begins to call into work more often, is very negative at work with their coworkers, and eventually decides to switch to a different department. The attributes that were present was fatigue as the nurse was continuously tired due to the extra time they must work, cynicism is experienced as the changing negative attitude to the coworkers, and the feeling of being overwhelmed is seen as the nurse struggles with the patient load.
A Borderline Case is having one or two of the attributes noted previously missing. An example of a Borderline Case with this scenario is a new nurse begins working in a fast-paced, busy emergency department. After completing the designed orientation period, the new nurse works a regular schedule for the next year. The nurse is met with many unfavorable patient and family encounters and often struggles with the patient load. The nurse also experiences conflict with coworkers. The nurse often feels underappreciated but continues to work in the emergency department. The attributes that were missing were fatigue and cynicism. While the nurse still felt overwhelmed at times, they were not overworked and had the time to destress and to have a balance between work and home life.
The Contrary Case is a case the demonstrates the opposite of the chosen attributes and nursing concept. An example of a Contrary Case in this scenario is a new nurse begins working in a fast-paced, busy emergency department. After completing a detailed orientation period, the new nurse works a regular work schedule for the next year. The nurse experiences meaningful encounters with patients and family members which help to justify the reasons that the nurse went into the nursing profession. The nurse also has no conflicts with co-workers as a result of the positive environment and the nurse feel as if they have found the perfect fit for their job. In this case, all attributes of fatigue, cynicism, and the feeling of being overwhelmed were exempt. The nurse was able to have a balance between work and home life as well as a positive work environment.
Theoretical Applications of the Concept
The purpose of concept analysis in relation to theory is that concept analysis can create new ideas or insights that can assist with the development of theory. “Concept analysis identifies the gaps in knowledge or measurements that should be taken in theoretical work” (McCarthy and Fitzpatrick, 2016, p.4). Through concept analysis, theoretical advancements are able to be made in nursing practice. The concept of burnout is relevant to the Self Efficacy Theory by Alberta Bandura. The Self Efficacy Theory believes that a person’s self-efficacy may be “influenced by behaviors, environment, and cognitive factors, with the most effective way of creating efficacy is through mastery of experiences” (Bandura, 1994).
When people experience failures or negative environments/emotions these also can impact self-efficacy negatively. In relation to burn out, burn out is the response the body has to the negative self-efficacy that has been developed through lack of personal/profession achievement. Burnout directly impacts work performance and production, as a result, this “decreased work performance may negate expectations for satisfaction, power, and compensation” (Chang et al., 2018). When workers have a positive self-efficacy, they have positive outlooks and outcomes at work, as this can be linked directly to their confidence. Burnout directly impacts this by lowering the confidence of workers and creating an environment of hopelessness and underappreciated services.
Conclusion
Burnout is an occurrence that may affect nurses from all specialties. Those who experience burnout may experiences fatigue/exhaustion, feelings of cynicism to distance themselves from the jobs, and feelings of being overwhelmed due to the inability and helplessness that they may feel while at work. The theory of Self-Efficiency by Bandura was applied to burnout as burnout can negatively impact either the worker’s performance or their perceptions of their abilities. As a nurse practitioner, this concept can be applied as a way to identify the warning signs of burnout.
Also, by learning the Self-Efficiency theory basis I can inspire myself and others to focus on positive influences to combat burnout. From this analysis, I learned the effects that burnout may have on a person along with the presenting signs/symptoms and how it may affect the work environment. I also learned strategies through Bandura’s theory of Self-Efficiency to influence positive outcomes within my practice to apply to try to combat not only burnout but also other negative influences.
