Professional Burnout among Physicians and Nurses in Asian Intensive Care Units: a multinational survey
Burnout syndrome (BOS) is a multifactorial concept which characterises job-related stress in any health care environment. ICU setting constitutes a potential stressor for physicians and nurses due to its technically complex and emotionally demanding working conditions. A growing body of evidence has identified a high prevalence of BOS amongst ICU physicians and nurses in Western countries, which may compromise staff well-being, but also patients’ care quality.
The team – led by Kay Choong See – proposes an in-depth study on BOS among Asian ICU physicians and nurses. Three survey instruments were employed: Maslach Burnout Inventory—Human Services Survey; Cohen Perceived Stress Scale and Patient Health Questionnaire for depression screening.
992 ICU physicians (76.5%) and 3100 ICU nurses (63.3%) from 17 Asian countries completed the above questionnaires via SurveyMonkey. Additionally, all ICU directors completed a web-based survey, which collected information on organisational characteristics. Countries and regions were grouped according to the World Bank 2015 classification.
Burnout rates ranged from 34.6% (Bangladesh) to 61.5% (Hong Kong) with the upper-middle income group having the highest average burnout rates compared to both the lower and higher income groups. ICUs physicians and nurses shared similarly high-levels of burnout (physicians 50.3%, nurses 52.0%, p=0.362), stress, and possible depression, whilst high burnout was positively associated with stress/depression (p<0.001).
Religiosity was associated with decreased burnout for both physicians and nurses. For physicians, years of working in the current department, shift work and stay-home night calls were also associated with decreased burnout. For nurses, better work-life balance was associated with decreased burnout. Although there is a paucity in interventional research, a recent randomised control trial suggests that education, role-play, and debriefing results in a lower prevalence of job strain at 6 months amongst French ICU nurses.
STUDY STRENGTHS & LIMITATIONS
This is the first, large study evaluating BOS and its related risk factors among Asian ICU staff; results show a high prevalence, similar to studies conducted in Western Europe and US, and reveals ways to improve quality of life at work, both at individual and institutional level. Nevertheless, the cross-sectional design does not allow to make casual inferences.
TAKE HOME MESSAGE
Professional burnout presents a high prevalence among Asian ICU staff members.
High work demand and poor work-life balance are pointed out as predominant risk factors.
Regular screening might help implementing effective interventions respecting social, economic and cultural differences.
This article review was prepared and submitted by Katerina Iliopoulou, from the N&AHP, on behalf of the Journal Club.
1) The Lancet, The LR. Burnout syndrome in the ICU-a sign of the times? Respiratory medicine. 2016 Aug;4(8):593.
2) Chuang CH, Tseng PC, Lin CY, Lin KH, Chen YY., Burnout in the intensive care unit professionals: a systematic review. Medicine. 2016 Dec; 95(50).
3) See KC, Zhao MY, Nakataki E, Chittawatanarat K, Fang WF, Faruq MO, Wahjuprajitno B, Arabi YM, Wong WT, Divatia JV, Palo JE, Professional burnout among physicians and nurses in Asian intensive care units: a multinational survey. Intensive care medicine. 2018 Dec 1; 44(12): 2079-90.
4) Papazian L, Sylvestre A, Herridge M., Should all ICU clinicians regularly be tested for burnout? Yes. Intensive Care Med (2018) 44: 681.
5) El Khamali R, Mouaci A, Valera S, Cano-Chervel M, Pinglis C, Sanz C, Allal A, Attard V, Malardier J, Delfino M, D’anna F., Effects of a multimodal program including simulation on job strain among nurses working in intensive care units: a randomized clinical trial. Jama. 2018 Nov 20; 320(19): 1988-97.