Workforce studies often identify burnout as a nursing ‘outcome’. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout. We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce. Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave. The patterns identified by these studies consistently show that adverse job characteristics—high workload, low staffing levels, long shifts, and low control—are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach’s theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.

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Burnout in nursing: a theoretical review

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing. This meta-analysis of 419 randomized controlled trials found that various types of psychological interventions could improve mental wellbeing in clinical and non-clinical populations. Effect sizes tended to be small to moderate and were influenced by various moderators.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing.

Background:The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.Objective:The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.Research Design:Relevant s

/pdf/a-meta-analysis-of-the-associations-between-the-nurse-work-dluqnb2hl3.pdf

A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes.

A meta-analysis of the prevalence of depressive symptoms in Chinese older adults

Aims and objectives To investigate the prevalence and extent of burnout on nurses and its association with personal resilience. Background With the worldwide shortage of nurses, nurse burnout is considered one of the main contributing factors and has been the focus of studies in recent years. Given the well-documented high level of burnout among nurses, resilience is expected to be a significant predictor of nurse burnout. The association between burnout and resilience has not previously been investigated extensively. Design A cross-sectional survey design was selected. Methods A total of 1,061 nurses from six separate three-level hospitals in Hunan Province, China, returned self-reported questionnaires from March-June 2015. Data were collected using a socio-demographic sheet, Maslach Burnout Inventory-General Survey and the Connor-Davidson Resilience Scale. Results Nurses experienced severe burnout symptoms and showed a moderate level of resilience. Three metrics of burnout had significantly negative correlations with the total score and following variables of resilience. Linear regression analysis showed resilience, especially strength, demographic characteristics (exercise, alcohol use and marital status) and job characteristics (income per month, ratio of patients to nurses, shift work and professional rank) were the main predictors of the three metrics of burnout. Conclusion The findings of this study may help nurse managers and hospital administrators to have a better understanding of nurse burnout and resilience. The significantly negative relationship between burnout symptoms and resilience has been demonstrated, and this informs the role of resilience in influencing burnout. Relevance to clinical practice Adaptable and effective interventions for improving resilience are needed to relieve nurses' burnout and reduce workplace stress. Moreover, nurse managers and hospital administrators should establish an effective management system to cultivate a healthy workplace and adopt positive attitudes and harmonious relationships.

Burnout and its association with resilience in nurses: A cross-sectional study.

The effects of group reminiscence therapy on depression, self-esteem, and affect balance of Chinese community-dwelling elderly.

In this study, we focused on measuring levels of nurse burnout and job dissatisfaction in the daily practice of nurses in Hunan province, China, analyzed factors related to nurse burnout and job dissatisfaction, and explored the relationship between them. Previous studies have shown a high level of burnout and job dissatisfaction among nurses worldwide. A cross-sectional survey of 1100 nurses was conducted. The nurses worked at 20 hospitals in 11 cities and counties throughout China's Hunan province. Nurse burnout was measured by the Maslach Burnout Inventory. Nurse-rated job dissatisfaction was described using a four point scale, and work environment was measured using the Nursing Work Index - Practice Environment Scale. The results showed that nurses had high burnout scores and were dissatisfied with their jobs. Staffing, work environment, and work hours were all significantly associated with nurse burnout and job dissatisfaction. Adequate staffing, improved work environment, and reasonable work hours are related to decreasing nurse burnout and job dissatisfaction.

Job dissatisfaction and burnout of nurses in Hunan, China: A cross-sectional survey.

Objective: To investigate the problem behaviors of children from grades 4-6 and associated factors in the rural Hunan province of China. Design and Sample: Randomized cluster sampling in 3 rural areas of the Hunan province was used. 435 subjects were randomly selected from grades 4-6. Measures: A researcher‐designed questionnaire was used to find influential demographic, parental, and socioeconomic factors. The prediction test of problem children (PPCT) was used to assess problem behaviors. Results: The prevalence of the early child problem behaviors in our sample was 17.44%. Associated factors include gender, willingness to attend school, parents' expectations of the children's educational degree, parents working outside the home (left‐behind children), and children's feeling of their parents' understanding of them. Conclusions: The prevalence of children with problem behaviors was higher in rural areas in Hunan than in China as a whole. This may be partly explained by the fact that parents must often work in the cities and leave their children behind at home, increasing the chances that those children develop behavioral problems. This phenomenon also applies in other developing countries, making it a public health concern. Therefore, there is a need to prevent problem behaviors through collaboration among families, schools, and society.

Sociodemographic Correlates of Behavioral Problems Among Rural Chinese Schoolchildren

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The effects of group reminiscence therapy on depression, self-esteem, and affect balance of Chinese community-dwelling elderly.

Job dissatisfaction and burnout of nurses in Hunan, China: A cross-sectional survey.

Sociodemographic Correlates of Behavioral Problems Among Rural Chinese Schoolchildren