Please include a title page and use level headings. To ensure the paper is organized, be sure to hit all eight parts of the required assignment and title each section.

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Concept analysis is “a process of examining the basic elements of a concept” (Walker & Avant, 2005, p. 64). Concept analysis is required when concepts need to be clarified, or further development is required to define them for nursing research, theory development, or practice.

At the end of Week 6, your concept analysis paper will be due. Start to think about which concepts you are interested in and require further clarification. Starting off with a simple google search of concept analyses may be of help.

You need to incorporate how the attributes, antecedents, and consequences tie into actual practice activites. Also a limitations section is needed Please thoroughly review the assignment guidelines/grading rubric. An abstract is not required for the assignment.

Concept Analysis Paper: Nurse Burnouts

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Concept Analysis Paper: Nurse Burnouts

The selected nursing concept is nurse burnouts. According to Dall’Ora et al. (2020), burnouts refer to a state of emotional, physical, social, and mental exhaustion caused by negative impacts of unmanaged stress within the work environment. Burnouts are social issues experienced by human service professionals. Yuan and Xu (2020) add that numerous research studies have examined the issue of nurse burnouts and provided sufficient evidence to facilitate understanding of the concept, including its antecedents and consequences within the healthcare environment. The purpose of this concept analysis paper is to present information about nurse burnouts including a description of the relevance of burnouts to nurses, identification of the uses of the concept, and a description of the attributes, consequences, and antecedents of the concept. The paper will also link the concept to actual practice activities and describe a specific case example. Finally, the paper will describe the limitations of the concept in nursing practice.

Relevance of the Concept to Nursing

The concept of nurse burnouts is relevant to nurses because research studies report that 35 percent to 45 percent of nurses report experiencing burnouts (Dyrbye et al., 2019). Nurses work in stressful work environments where they are expected to perform at capacity and most have no time to engage in self-care activities. As a result, they experience physical and compassion fatigue. Long-term exposure to stress within the work environment leads to burnouts (Dall’Ora et al., 2020). According to Shah et al. (2021), nurses in the U.S. make up more than 30 percent of healthcare personnel and are a critical group of healthcare professionals with significant influence on direct treatment, disease prevention, and health promotion. The increase in demand for healthcare services caused by demographic changes and increased incidence of chronic illnesses led to an ever-growing demand for nurses in numerous care settings leading to a nurse shortage. Most nurses are subjected to issues such as poor staffing ratios that increase the risk of burnout. Shah et al. (2021), in their research on the prevalence of nurse burnouts, identified that more than 30 percent of nurses leaving the profession report that they did so because of burnouts.

Uses of the Concept in Practice Settings

The term ‘burnout’ was originally developed in 1974 by Freudenberger after he observed a reduction in commitment and less motivation among volunteers who worked in a mental health clinic. Freudenberger described burnouts as the state of physical and emotional exhaustion resulting from an individual’s professional life. He also identified that burnouts are issues mainly experienced by human service workers. Maslach later made an in-depth analysis into the issue and developed the Maslach Burnout Inventory, an instrument used to measure the existence and severity of burnouts. Maslach described burnouts as responses to stressful work environments and mentioned depletion of emotional resources as the main symptom of burnouts. Maslach also mentioned that burnouts are a mismatch between an individual and six work dimensions including workload, reward, limited control over work resources, poor interpersonal relationships with colleagues, conflicting values, and unfairness in the workplace. Workloads are excessive work demands which limit recovery. Inadequate social, financial, and intrinsic rewards are also linked to reduced motivations and burnouts (Dall’Ora et al., 2020). Although the term burnouts can be used within the context of other disciplines such as education and psychology, it is mostly prevalent among nurses. In diverse healthcare settings where nurses work with patients with different health issues, burnouts are inevitable especially with issues such as nurse shortage, high workloads, and long shifts (Zeng et al., 2020).

 

Defining Attributes, Antecedents, and Consequences

Defining Attributes

The main defining attributes of the concept of nurse burnouts are depersonalization, emotional exhaustion, and a reduction in personal accomplishments. The burnout process is sequential in that it begins with gradual development of emotional exhaustion leading to depersonalization which in turn results in reduced satisfaction with personal accomplishments (Zeng et al., 2020).

Emotional Exhaustion refers to a state of emotional and physical depletion resulting from continuous stress and excessive professional demands. The main characteristics of emotional exhaustion include reduced motivation for work and in the case of nurses, increased inability to connect with patients at a personal level and provide effective care (Poku et al., 2020). When people interact with the external environment, emotional processing acts as the first response and it activates behavioral, cognitive, and psychological responses. Emotional strain is, therefore, a precursor to negative psychological, cognitive, and behavioral responses that negatively impact the quality of care by increasing the risk of errors and adverse events during care (Yuan & Xu, 2020).

Depersonalization refers to unfeeling responses towards healthcare consumers that include negative responses such as lack of empathy, apathy, and coldness towards the care recipient. Nurses with depersonalization are detached from the care process as a way of coping with work stressors hence the attribute represents the interpersonal impacts of nurse burnouts (Mudallal et al., 2017). Low personal accomplishment as an attribute refers to feelings of incompetence due to decreased productivity in the care process. Emotional exhaustion and depersonalization prevent nurses from effectively fulfilling their roles which in turn reduces their sense of effectiveness (Yuan & Xu, 2020).

Antecedents

Antecedents refer to the events that lead to the development of a concept. The main antecedents of nurse burnouts can be categorized into interpersonal, intrapersonal, and organizational factors. Organizational factors are the most significant factors that influence the risk of burnouts. Healthcare organizations are responsible for creating work environments that enhance motivation and promote high quality of care. However, some organizations use policies that make it difficult for nurses to work effectively. For instance, staff layoffs and long shifts with minimal breaks facilitate the development of burnouts. Other factors such as lack of career advancement opportunities, failure to involve nurses in the decision making process, strict supervision, and role conflicts lead to emotional exhaustion and depersonalization. Staff shortages, increased nurse workloads, lack of rewards, and injustices in the workplace also lead to burnouts (Nabizadeh-Gharghozar et al., 2020).

Interpersonal factors are those associated with nurse interactions with colleagues and other professionals within the workplace. These factors may include unfair criticisms from supervisors, lack of sufficient social support, work-family conflict, and negative relationships with colleagues. Intrapersonal factors are individual factors that impact nurses’ functioning within the healthcare environments and may include age, gender, work experience, marital status, and educational level. Research indicates that younger nurses are at high risk of experiencing burnouts in comparison to older nurses because of limited experience and insufficient coping skills. Female nurses are also more vulnerable because of high prevalence of issues such as work-family conflict and occupational stress which increase the risk of psychological distress. Marital status may act as a protective factor for nurse burnouts because of access to support from spouses and other family members. However, marital status may also increase the risk of burnouts especially if nurses fail to achieve a good work-life balance (Nabizadeh-Gharghozar et al., 2020). Personality trait is also a significant intrapersonal factor that influences burnouts. Character traits such as neuroticism are positively linked to burnouts while others such as agreeableness, extraversion, and conscientiousness are negatively linked to the development of burnouts (Zeng et al., 2020).

Environmental factors associated with burnouts include overcrowding, constant noise, and poor lighting. Such factors lead to issues such as impatience, fatigue, behavioral issues, and inefficiency. Noise pollution increases stress, anxiety, and fatigue among healthcare professionals. In contrast, work environments characterized by good ventilation, good lighting, and sufficient equipment reduces the risk of burnouts and increases job satisfaction. Notably, burnouts are common in nursing units frequented by high acuity patients such as burn care, emergency departments, intensive care, and neonatal units. Workplaces characterized by violence from colleagues or patients increase the risk of psychological damage and burnouts (Nabizadeh-Gharghozar et al., 2020).

Consequences

Consequences are events that occur as direct impacts of the concept. The main consequences of nurse burnouts can be categorized into nurse-related, patient-related, and organization-related consequences. Nurse-related consequences include increased risk for development of mental and physical health issues. Burnouts lead to the development of sleep disorders, depressive disorders, and chronic illnesses such as hypertension which reduce the quality of life of nurses. Additionally, burnouts increase the risk of developing substance abuse problems such as alcohol misuse and smoking which further reduce the nurses’ ability to treat patients. Other nurse-related consequences include high rates of medication errors and low quality care (Nabizadeh-Gharghozar et al., 2020).

Patient-related consequences are related to reduced quality of care and may include impaired recovery, increased length of stay in hospitals, and increased mortality rates. Patients treated by nurses who demonstrate depersonalization also report lower levels of satisfaction with care (Nabizadeh-Gharghozar et al., 2020). Organization-related consequences include poor relationships between nurses and other staff members, high turnover rates which lead to nurse shortages, reduced quality of care, and reduced productivity. Organizations may experience revenue reduction because patients will opt for other medical facilities with better quality of care (Kelly et al., 2021).

Linking the Defining Attributes, Antecedents, and Consequences to Actual Practice Activities

In actual practice, burnouts are a common occurrence. The antecedents of burnouts can be generally categorized into poorly managed occupational stress and lack of social and managerial support. Nurses generally spend more time with patients in comparison to other professionals. However, when workloads are unmanageable, nurses are often forced to accomplish their tasks in short time periods hence they have no time to establish professional relationships with patients. For example, in the emergency departments, nurses have to attend to many patients at once so they only have time to check vital signs to determine the severity of illness or injury and refer patients to physicians and other professionals. In some situations, their supervisors do not show any appreciation for their efforts. Some organizations do not bother to hire sufficient nursing staff or give nurses reasonable wages based on the amount of effort they put in. Nurses often have limited resting hours and some can even work for years without taking vacations. Furthermore, some healthcare institutions do not allow nurses to take long leaves when they experience tragedies such as loss of loved ones. Such factors increase the risk of emotional and physical fatigue.

In a qualitative study that assessed the consequences of nurse burnouts, Rudman et al. (2020) determined that nurses demonstrate signs of emotional and physical exhaustion as early as within the first three years of practice. Most nurses report experiencing depression symptoms, sleep disturbances especially insomnia, and a decline in cognitive processing and functioning. Nurses also report feeling irritable and distracted when they are sleep-deprived and tired which lead to a feeling of indifference. Such feelings have a negative impact on task performance which leads to less job satisfaction and increased desire to leave the nursing profession.

Case Example (Model Case)

Alexis works as a staff nurse in the intensive care unit of a large nonprofit community hospital located in an inner Detroit. The unit has 70 beds that are usually fully occupied due to the extreme violence within the neighborhood. More than half of the patients are usually gun violence victims while the rest have severe chronic illnesses. All these patients require a lot of attention from the hospital staff due to their complex physical and mental health issues. Alexis is often placed on the night shift and due to nurse shortages, she often finds herself in charge of eight patients at a time. She barely has time to breath as she moves from one patient to another during the shifts. Some patients experience severe pain and often shout or scream if she fails to give their medication on time. Additionally, a significant number of patients are on organ support machines hence they require close monitoring. In the past two months, Alexis has talked to the nurse superior about increasing the number of nurses and nurse assistants in the unit but she was informed that the hospital cannot pay for more nurses since most patients they receive are low-income patients with no healthcare insurance to pay for the services.

Alexis has always felt emotionally and physically tired although recently, she began experiencing severe headaches and insomnia. She is unable to concentrate when attending to patients and during her past shift, she gave the wrong medication to a patient. Although the medication did not worsen the patient’s condition, she feels very guilty and useless as a nurse. Alexis is now seeking to leave the hospital and become a travel nurse to increase her freedom and access better pay.

This model case example illustrates how issues such as nurse shortages and high workloads can lead to burnouts. Alexis has gradually developed burnout symptoms including physical and emotional fatigue which have led to depersonalization and feelings of insufficiency. A contrary case would have described a situation where the nurse has access to sufficient resources and the hospital has a sufficient nursing staff which allows for tolerable workloads.

Limitations to Using the Selected Concept in Practice

As explained above, nurse burnout is a negative concept that results in negative consequences for healthcare organizations, nurses, and patients. Burnouts have a negative impact on nurse health, productivity, and quality of care. Therefore, all healthcare organizations should strive to develop interventions that reduce the risk of burnouts among the nursing staff. Some strategies that can be implemented include early recognition of nurse burnouts and provision of emotional and psychological support to mitigate their impacts. Psychological interventions such as mindfulness and meditation may help nurses cope with the stressors they encounter at work. Healthcare organizations should strive to create work environments that promote effective communication between nurses and managers. They should also improve nurse-to-patient ratios especially in units with high acuity patients. Additionally, nurses should be involved in organization policy discussions and decision making regarding issues that affect patient care (Aryankhesal et al., 2019).

Empirical referents

Empirical referents refer to the categories of real phenomena whose existence illustrates the concept’s occurrence. Many instruments have been developed to assess nurse burnouts including the defining attributes and consequences. Examples of such instruments include the Copenhagen Burnout Inventory and the Maslach Burnout Inventory. Both instruments are valid and reliable. However, there is no instrument that specifically measures burnouts among nursing professionals. Based on the impacts of burnouts on nurses, patients, healthcare organizations, and the entire healthcare industry, it is important to determine effective strategies for accurately measuring nurse burnouts (Zeng et al., 2020).

Conclusion

Burnout is a significance issue that is relevant to the nursing profession since nurses are bound to encounter work stressors that increase the risk of physical and emotional fatigue. Burnouts are caused by inability to cope with occupational stress and insufficient social and managerial support. The consequences of nurse burnouts include negative physical and emotional health for the nurses, increased feelings of indifference when working with patients, and reduced sense of efficacy. Nurses experiencing burnouts provide poor quality care which leads to poor patient outcomes. Additionally, burnouts are linked to high nurse turnover and increased number of nurses leaving the nursing profession. Based on these findings, it is important for healthcare organizations to implement interventions such as improving nurse staffing, creating conducive work environments, and involving nurses in decision making to reduce the risk of burnouts. The impacts of burnouts can be mitigated through improved self-care and use of meditation or mindfulness techniques.

References

Aryankhesal, A., Mohammadibakhsh, R., Hamidi, Y., Alidoost, S., Behzadifar, M., Sohrabi, R., & Farhadi, Z. (2019). Interventions on reducing burnout in physicians and nurses: A systematic review. Medical Journal of the Islamic Republic Of Iran, 33(77). https://doi.org/10.47176/mjiri.33.77

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1). https://doi.org/10.1186/s12960-020-00469-9

Dyrbye, L., Shanafelt, T., Johnson, P., Johnson, L., Satele, D., & West, C. (2019). A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0382-7

Kelly, L., Gee, P., & Butler, R. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96-102. https://doi.org/10.1016/j.outlook.2020.06.008

Mudallal, R., Othman, W., & Al Hassan, N. (2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 004695801772494. https://doi.org/10.1177/0046958017724944

Nabizadeh-Gharghozar, Z., Adib-Hajbaghery, M., & Bolandianbafghi, S. (2020). Nurses’ Job Burnout: A Hybrid Concept Analysis. Journal of Caring Sciences, 9(3), 154-161. https://doi.org/10.34172/jcs.2020.023

Poku, C., Donkor, E., & Naab, F. (2020). Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-00512-z

Rudman, A., Arborelius, L., Dahlgren, A., Finnes, A., & Gustavsson, P. (2020). Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. Clinical Medicine, 27, 100565. https://doi.org/10.1016/j.eclinm.2020.100565

Shah, M., Gandrakota, N., Cimiotti, J., Ghose, N., Moore, M., & Ali, M. (2021). Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Network Open, 4(2), e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469

Yuan, C., & Xu, C. (2020). Concept analysis of nurse burnout. Frontiers of Nursing, 7(3), 227-233. https://doi.org/10.2478/fon-2020-0034

Zeng, J., Xiao, A., Ye, J., Cai, H., Li, W., & Xia, Z. et al. (2020). Occupational burnout in nurses: a concept analysis†. Frontiers of Nursing, 7(1), 1-8. https://doi.org/10.2478/fon-2020-0006