Burnout among nursing students: predictors and association with empathy and self-efficacy

Burnout Risk Profiles in Psychology Students: An Exploratory Study with Machine Learning

University students are at increased risk of developing burnout and psychological distress from high academic workloads and performance expectations. The purpose of this study is to analyze the relationship between psychological and lifestyle variables and academic burnout, as well as to identify burnout risk profiles in psychology students. This study used a cross-sectional design and included 274 Portuguese psychology students, the majority being undergraduates (72.6%). Participants were assessed on psychological well-being, psychological distress, difficulties in emotional regulation, type of diet, physical activity, sleep quality, and burnout. The results showed that psychological distress, difficulties in emotional regulation, and sleep quality were positively associated with burnout, while psychological well-being was negatively associated. Using machine learning algorithms, two distinct profiles were found: "Burnout Risk" and "No Risk". A total of 62 participants were identified as belonging to the burnout risk profile, showing higher levels of distress, emotional regulation difficulties, poor psychological well-being and sleep quality, pro-inflammatory diet, and less physical activity. The accuracy of the three machine learning models-Random Forest, XGBoost, and Support Vector Machine-was 95.06%, 93.82%, and 97.53%, respectively. These results suggest the importance of health promotion within university settings, together with mental health strategies focused on adaptive psychological functioning, to prevent the risk of burnout.

Vocation of Human Care and Soft Skills in Nursing and Physiotherapy Students: A Cross-Sectional Study

Background: Empathy and assertiveness are two essential soft skills for health professionals such as nurses or physiotherapists. Both professions are characterised by their contribution to preserving and improving health and human care, and for their vocation of service. One of the achievements of the training is the voluntary, conscious, and individually inspired career choice. Objectives: This study aimed to evaluate the empathy, assertiveness, and care vocational levels among undergraduate students enrolled in Nursing and Physiotherapy Degree programmes and to investigate the relationship between these soft skills and the care vocation. Methods: A cross-sectional study of nursing and physiotherapy students was conducted in the 2023/2024 academic year. The Interpersonal Reactivity Index scales for empathy, the Rathus test for assertiveness, and the "Vocation of Service for Human Care" questionnaire were used as study tools. Finally, 226 nursing and physiotherapy students participated after providing informed consent, excluding those on national or international exchange programmes. Results: The empathy, assertiveness, and vocation of service for human care of the students was found to be acceptable. Significant differences were observed according to the gender variable or career among the students, with female students presenting better results in empathy subscales or vocation (p < 0.05). Students who were working or had clinical experience in other professions scored lower on the empathy personal distress subscale (p < 0.05). Conclusions: Both nursing and physiotherapy students demonstrate satisfactory levels of empathy, assertiveness, and vocation for human care. However, gender and previous work experience notably influence these scores. It would be beneficial to conduct long-term studies with educational interventions to train and develop empathy, assertiveness, and vocation for human care.

Determinants of burnout syndrome among undergraduate nursing students in Poland: a cross-sectional study

BACKGROUND

Nursing students worldwide are exposed to burnout syndrome resulting from constant academic and clinical stressors. The consequences of student burnout can be related to the student's mental and physical health. Burnout may affect the learning process, achieving professional skills, and future effectiveness while working with a patient and, eventually, might lead to the decision to quit the job. This study aims to analyze the intensity of burnout syndrome among undergraduate nursing students based on their year of study (1), establishing the impact of stress, anxiety, insomnia, and selected sociodemographic variables on the level of burnout (2) and establishing a student profile predestined to be affected by burnout (3).

METHODS

A cross-sectional study was conducted among 841 bachelor's degree nursing students from March 2022 to June 2022. The Maslach Burnout Inventory, Athens Insomnia Scale, Modified Hospital Anxiety and Depression Scale, and Perceived Stress Scale were used.

RESULTS

High levels of emotional exhaustion were found in 40.9% and depersonalization in 20.33%, while low personal accomplishment was found in 16.88% of the students. Students of nursing in Year 2 presented the highest levels of emotional exhaustion and depersonalization and achieved significantly higher scores on the Athens Insomnia Scale. The determinants of burnout syndrome identified by the regression analysis were: sociodemographic factors (age, gender, and financial resources), the factors connected with the studying environment (year of studies and clinical and academic stressors), and emotional/mental/interpersonal factors (anxiety, depression, insomnia, and intensity of stress related to life situations).

CONCLUSION

The academic community should be encouraged to create a more supportive environment for students, which will ultimately prevent dropouts and increase the number of nursing professionals in the Polish healthcare system. We recommended carrying out regular screening tests for burnout, insomnia, anxiety, stress, and depression (e.g., once a year) among students. Depending on the results of the tests, implementation of interventions aiming at reducing the negative outcomes of burnout syndrome and promoting well-being and adaptive management mechanisms should be considered.

Burnout among nurses practicing in critical care units: Predicting the contributing factors

BACKGROUND

Critical care nurses work in complex healthcare environments, which makes them more susceptible to burnout. Despite extensive research on burnout among nurses no previous study targeted burnout contributing factors in Iraq. Thus, this study aimed to determine the predicting the most influential factors in the development of burnout among critical care nurses.

MATERIALS AND METHODS

A descriptive correlational design was used with 377 nurses who were practicing in critical care units in 13 public teaching hospitals in Iraq. Data were collected using socio-demographic, professional characteristics of nurses, Nurses Alarm Fatigue questionnaire, Depression Anxiety Stress Scale, and Burnout Assessment Tool. Descriptive statistics and multiple regression were used for data analysis.

RESULTS

The multiple regression showed that nurses' anxiety, stress, alarm fatigue, depression, and time span positively predict nurses' burnout (P value = .000.,000.,000.,033.,036), respectively. On the other hand, only nurses' age inversely predicts burnout level (P value = .008).

CONCLUSION

Anxiety, stress, alarm fatigue, depression, and time span are the most influential factors in the development of burnout. Age was the only variable that predicted burnout inversely.

Development and validation of a machine learning-based predictive model for compassion fatigue in Chinese nursing interns: a cross-sectional study utilizing latent profile analysis

BACKGROUND

Compassion fatigue is a significant issue in nursing, affecting both registered nurses and nursing students, potentially leading to burnout and reduced quality of care. During internships, compassion fatigue can shape nursing students' career trajectories and intent to stay in the profession. Identifying those at high risk is crucial for timely interventions, yet existing tools often fail to account for within-group variability, limiting their ability to accurately predict compassion fatigue risk.

OBJECTIVES

This study aimed to develop and validate a predictive model for detecting the risk of compassion fatigue among nursing students during their placement.

DESIGN

A cross-sectional study was used to capture the prevalence and associations of compassion fatigue among nursing interns, as it allows for timely assessment of key influencing factors without requiring long-term follow-up.

METHODS

A convenience sampling strategy was used to recruit 2256 nursing students from all ten public junior colleges in Hunan province in China between December 2021 and June 2022. Participants completed questionnaires assessing compassion fatigue, professional identity, self-efficacy, social support, psychological resilience, coping styles, and demographic characteristics. Predictors were selected based on prior literature and theoretical frameworks related to compassion fatigue in nursing. Latent profile analysis was used to classify compassion fatigue levels, and potential predictors were identified through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression. Eight machine learning algorithms were applied to predict compassion fatigue, with performance assessed through cross-validation, calibration, and discrimination metrics. The best-performing model was further validated to ensure robustness.

RESULTS

A three-profile model best fits the data, identifying low (55.73%), moderate (32.17%), and severe (12.10%) profiles for compassion fatigue. Generally, an area under the curve (AUC) above 0.700 is acceptable, and above 0.800 indicates good predictive performance. The AUC values for the eight machine learning models ranged from 0.644 to 0.826 for the training set and 0.651 to 0.757 for the test set, indicating moderate to good discriminatory ability. The eXtreme Gradient Boosting (XGBoost) performed best, with AUC values of 0.840, 0.768, and 0.731 in the training, validation, and test sets, respectively. Shapley Additive Explanation (SHAP) analysis interpreted the model by quantifying the contribution of each variable to the prediction, revealing that psychological resilience, professional identity, and social support were the key contributors to the risk of compassion fatigue. A user-friendly, web-based prediction tool for calculating the risk of compassion fatigue was developed.

CONCLUSIONS

The XGBoosting classifier demonstrates excellent performance, and implementing the online tool can help nursing administrators manage compassion fatigue effectively. It holds practical value for nursing education and practice by supporting early detection and intervention. Future research should validate its use across settings, and longitudinal studies could assess its long-term impact.

Internationalization at home program significantly increases the self-efficacy of nursing students: A pre-post study

BACKGROUND

Internationalization at home strategies seek to achieve a more inclusive and equitable higher education. Evidence about the impact of these strategies on students' self-efficacy is still scarce, even though this psychological construct is essential for the performance and well-being of nursing students. The Global Nursing Care program was designed to provide nursing students with an internationalization at home experience, combining a virtual exchange and international clinical simulation.

AIM

To determine the impact of the Global Nursing Care program on nursing students' self-efficacy.

DESIGN

A quasi-experimental, analytic, and longitudinal study was conducted.

SETTINGS AND PARTICIPANTS

The virtual module was carried out online, and the international simulations were developed in the Simulation Centers of the San Juan de Dios School of Nursing and Physiotherapy (Universidad Pontificia Comillas, Spain) and the West Coast University (USA). Seventy students participated in the program and 57 completed the pre-post questionnaire.

METHODS

Data were collected using an online survey that included a sociodemographic questionnaire and the General Self-efficacy Scale. IBM's SPSS (version 28.0.1.1) was used to analyze data. Differences between self-efficacy levels were measured before and after the program, and according to sociodemographic characteristics.

RESULTS

General self-efficacy was significantly augmented following program participation (pre-intervention: mean = 32.39, SD = 3.87; post-intervention: mean = 34.44, SD = 3.86; p < 0.001). No differences based on nationality, previous international academic experience or academic year were found.

CONCLUSIONS

An internationalization at home program based on virtual exchange and simulation improves nursing students' general self-efficacy. Future research can explore to what extent this effect persists over time.

The prevalence and related factors of compassion fatigue among nursing interns: a cross-sectional study

BACKGROUND

Compassion fatigue is common among nurses and can lead to decreased motivation, impaired physical and mental health, and turnover. Nursing interns often face environments the same as professional nurses, yet their compassion fatigue has received less attention. Therefore, this study aims to assess the prevalence and related factors of compassion fatigue among nursing interns.

METHODS

This was a cross-sectional study involving 221 nursing interns in 2 tertiary-level hospitals in Shanghai, China. A general information questionnaire was formulated to investigate the demographic characteristics and internship-related factors of nursing interns. Compassion fatigue was assessed using the Professional Quality of Life Scale [compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS)]. Psychological resilience, empathy, and perceived stress were evaluated by the Connor-Davidson Resilience Scale, Jefferson Scales of Empathy, and Perceived Stress Scale, respectively. Personality traits were assessed using the extroversion/introversion subscale of the Eysenck Personality Inventory. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation analysis, and multiple linear regressions were used to determine the predictors of the main research variables.

RESULTS

The prevalence of mild, moderate, and severe compassion fatigue in 221 nursing interns (mean age 21 years, 202 [91.4%] females) was 10.4%, 46.6%, and 43.0%, respectively, and their mean scores for CS, BO, and STS were 29.75 ± 6.39, 28.72 ± 4.78, and 28.51 ± 7.51, respectively. Psychological resilience and empathy were the strongest protective factors for CS and BO, respectively (p < 0.001), and the number of night shifts monthly was the most significant positive independent predictor of STS (p = 0.001). Additionally, male gender negatively predicted CS (p = 0.009). Younger age and extended daily working hours were associated with elevated levels of both BO and STS (p < 0.05). Clinical nursing teachers with intermediate or senior titles, as well as departments of pediatrics and obstetrics had a positive effect on STS (p < 0.05), while internship time had a negative effect on STS (p = 0.005). Furthermore, the variables of perceived stress, personality traits, and choice of nursing profession did not exhibit statistical significance in the multivariate analysis. Related factors predicted 14.2%, 26.2%, and 23.9% of the variance in the model of CS, BO and STS, respectively (all P < 0.001).

CONCLUSION

The compassion fatigue of nursing interns was more serious, especially for nursing interns who were male and younger, and who had shorter internship time, departments of pediatrics and obstetrics, and clinical nursing teachers with intermediate or senior titles. Nursing educators can improve the psychological resilience and empathy of nursing interns by offering relevant psychological courses according to the different stages of internship, as well as rationalizing their daily working hours and the frequency of night shifts to improve the compassion fatigue of nursing interns.

REGISTRATION NUMBER

ChiCTR2400081968.

Past the tipping point: Understanding and addressing burnout among nursing students

Burnout is a widespread concern in healthcare, with nurses bearing a disproportionate burden among healthcare professionals. This epidemic of occupational stress has also affected nursing students, who face the external demands inherent in the profession. In this call-to-action paper, we conducted an extensive literature review exploring strategies aimed at mitigating burnout among nursing students, and offer recommendations for academic institutions, healthcare leaders, research funders, and political leaders, including both the civil service and elected leaders to support the advancement and sustainability of the nursing profession and its workforce.

Development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy scale for professional caregivers

AIM

To develop and validate a scale for measuring professional caregivers' ethical self-efficacy in dementia care.

BACKGROUND

Professional caregivers of people with dementia make ethical decisions on a day-to-day basis, and it is important that they feel confident when doing so. Moreover, confidence, or self-efficacy, influences caregivers' behaviour and well-being and may be a predictor of competence. However, there is no scale for measuring ethical self-efficacy. This study aims to fill this gap.

METHODS

This study concerns the development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy (DemESE) scale. During development, we identified dementia-specific ethical principles and generated items representing ethical conflicts of principles. In the subsequent validation, we administered the scale to experts and professional caregivers in dementia care. We assessed the relevance of the scale using a content validity index and tested validity and reliability using Cronbach's alpha. To further enhance validity, we compared the scale with analogous self-efficacy scales using Pearson's correlation coefficient.

RESULTS

The quantitative testing of DemESE revealed that the scale exhibited acceptable levels of internal consistency and reliability. This finding was supported by Cronbach's alpha. In addition, the content validity index and Pearson correlation coefficient provided evidence of the scale's relevance and validity.

CONCLUSION

The results suggest that DemESE is a promising tool for assessing professional caregivers' ethical self-efficacy in dementia care and may be used to measure ethical self-efficacy - that is, confidence in ethical decision-making in dementia care.

The role of Empathy in the relationship between emotional support and caring behavior towards patients among intern nursing students

BACKGROUND

The empathic relationship between nursing students and patients allows them to understand and address caring behavior for patients. Appropriate emotional support equips them to overcome the complexities and difficulties inherent in patient care. This support cultivates resilience and self-awareness, enabling students to manage their emotions effectively and establish meaningful connections and caring with their patients.

OBJECTIVES

To investigate the role of empathy in the association between emotional support and caring behavior toward patients among intern nursing students at Alexandria and Damanhur University.

SUBJECTS

The study subjects were 200 intern nursing students in their internship years of 2022-2023, randomly selected from an equal sample size from Alexandria and Damanhur University, Egypt.

TOOLS

A questionnaire of social information& academics from students, the Toronto Empathy Questionnaire, the Caring Dimension Inventory, and the Multidimensional Scale of Perceived Social Support are used to collect participants' data.

RESULTS

Empathy was associated with caring behavior and emotional support among nursing students (P < 0.001), and higher levels of empathy indicated increased levels of caring behavior and emotional support. The caring behavior significantly increased when intern nursing students received more emotional support and among those who were not working in private hospitals (p < 0.001,&p = 0.023 respectively). Empathy acts as a mediating role in the relationship between emotional support and caring behavior.

IMPLICATIONS

Implementing strategies to assist interns in navigating challenges and promoting a culture of support can facilitate the cultivation of caring behaviors. Shedding light on the interconnectedness of empathy, emotional support, and caring behavior can inform the design of interventions to strengthen empathy as a pathway to improving patient outcomes.

CONCLUSION

Empathy is a mediating factor in the relationship between emotional support and caring behavior. This suggests that interventions promoting empathy may serve as a pathway to enhancing caring behavior among nursing students and strategies for improving patient care outcomes by strengthening empathy skills among healthcare professionals.

Effects of burnout and work engagement in the relationship between self-efficacy and safety behaviours-A chained mediation modelling analysis

AIMS

To explore the current situation, influencing factors and pathways of safety behaviour of nurses in tumour specialized hospitals, in order to provide a theoretical basis for managers to manage and train nurses, improve their safety behaviour level and ensure medical safety.

DESIGN

An anonymous cross-sectional survey.

METHOD

A total of 2147 nurses from Grade A cancer hospitals in 15 provinces of China were selected by a convenient sampling method. Questionnaires were collected through the Questionnaire Star platform. Nurses' safety behaviour was measured using the nurse Safety Behaviour Scale, Self-efficacy by the General Self-efficacy Scale, and nurses' occupational burnout was measured by the occupational Burnout Scale, and work engagement through the the Work Engagement Scale. Structural equation modelling was used to test the relationship among nurses' safety behaviour, general self-efficacy, occupational burnout and work engagement. SPSS25.0 software was used to test the relationship among the safety behaviour of nurses, general self-efficacy, occupational burnout and work engagement.

RESULTS

The total score of safety behaviour of nurses was 55.45 ± 6.879, the total score of general self-efficacy was 31.39 ± 5.729, the total score of occupational burnout was 44.99 ± 26.587, and the total score of work engagement was 38.48 ± 13.433; the scores of the Nurse Safety Behaviour Scale, Self-Efficacy Scale, and Work Engagement Scale were positively correlated (all p < .001); the occupational burnout scale was negatively correlated with the scores of self-efficacy scale, work engagement scale and nurse safety behaviour scale (all p < .001); Structural equation model analysis shows that self-efficacy and work engagement have a direct positive impact on nurse safety behaviour(β = .103, β = .096, all p < .001); Occupational burnout has a direct negative impact on self-efficacy, work engagement and nurse safety behaviour(β = -.371, β = -.413, β = -.328 all p < .001). Bootstrap analysis showed that occupational burnout and job involvement had a significant chain mediating effect between self-efficacy and the safety behaviour of nurses (95% CI: 0.148-0.21). The total effect of self-efficacy on the safety behaviour of nurses was 0.283 (p < .001, 95% CI: 0.225-0.301), the direct effect was 0.096 (p < .001, 95% CI: 0.042-0.15), and the indirect effect was 0.179 (p < .001, 95% CI: 0.085-0.215), The mediating effect accounted for 63.3% of the total effect size.

CONCLUSION

Occupational burnout and work engagement play a partial mediating role between self-efficacy and nurse safety behaviour. It is necessary to strengthen training on nurse safety culture awareness, improve the nurse self-efficacy and work engagement, reduce nurse occupational burnout, and thereby improve the level of nurses' safety behaviour.

Assessment of Empathy as a Prerequisite for Holistic Nursing: Psychometric Analysis of the Jefferson Scale of Empathy-Health Profession Students for Croatian BSc and MSc Nursing Students

Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.

Causes of burnout in nursing seniors: A mixed methods study

BACKGROUND

In recent years, the issue of burnout in newly graduated and student nurses has become an increasing interest of researchers. Burnout seriously affects the behavior, health, life and relationships of individuals.

OBJECTIVES

This research was conducted to investigate the causes of burnout in nursing senior students in depth.

DESIGN

This research, based on mixed method, was carried out with a sequential exploratory design.

PARTICIPANTS

The study was conducted with 148 nursing students in their last year at a university in the Marmara Region of Türkiye.

METHOD

Data were collected with Personal Information Form, The Burnout Measure Short Version (BMS) and Maslach Burnout Inventory-Student Form (MBI-SF) between March and April 2022. Qualitative interviews were conducted face-to-face with 16 students determined by criterion sampling method between May and June 2022. A semi-structured interview form was used to collect qualitative data. Descriptive statistics (number, percentage, mean, standard deviation) were used for the analysis of quantitative data. Thematic analysis was performed for qualitative data.

RESULTS

The mean BMS total score for the sample group was 4.50. MBI-SF sub-dimension mean scores; It is in the form of exhaustion (16.52), depersonalization (12.66) and competence (12.41). According to the scores of nursing senior students from BMS, it was determined that 22.3 % (n = 33) had burnout, 23 % (n = 34) had a serious burnout problem, and 28.4 % (n = 42) needed professional help as soon as possible. In addition, three main themes emerged as a result of the thematic analysis: (i) Effects of Burnout, (ii) Factors Affecting Burnout, (iii) Ways to Cope with Burnout.

CONCLUSION

It was determined that one of the five nursing students was in danger of burnout. The prevalence of burnout in nursing senior students was 73.7 %. Besides, it was determined that the problems experienced in the student's nursing education and professional practices, the pandemic process, financial concerns, family-related situations, not finding time for social activities, and future anxiety were the factors causing burnout.

The effects of empathic communication skills training on nurse practitioner students

ABSTRACT

Evidence regarding the impact of empathic communication training on nurse practitioner (NP) students is lacking. Despite increasing emphasis within practice settings in the United States, formal communication training for NP students has been modestly integrated into curriculum, based on limited data supporting its efficacy. As such, we sought to evaluate the impact of empathic communication training on NP students' self-efficacy with empathic communication. This is a quasi-experimental study of a single group of NP students (n = 49) who participated in empathic communication training with pretraining/posttraining measurements using the Self-Efficacy-12 instrument. There were statistically significant improvements in students' comfort and confidence with nine of the 17 items surveyed. Several other domains also showed improvement approaching statistical significance. Based on our results, empathic communication training increases NP students' self-efficacy with empathic communication.

Academic burnout among undergraduate nursing students: A quantitative survey approach

BACKGROUND

Exposure of nursing students to constant work pressure, stress, and emotional turmoil during both clinical and theoretical sessions of nursing training often leads to academic burnout among them. The aim of the study was to determine the presence of academic burnout among undergraduate nursing students and the association of academic burnout with age, gender, year of nursing program, residence location, and relaxation technique practice.

MATERIALS AND METHODS

A descriptive survey design was used, and data were collected from 266 undergraduate nursing students from Udupi Taluka, South India. Baseline information was collected through a demographic proforma, and Oldenburg Burnout Inventory for Students was used for assessing academic burnout. A stratified proportionate sampling technique was used to select the study sample. The data were collected from April 2021 to May 2021. Descriptive and inferential statistics were used for the analysis by using Statistical Package for the Social Sciences (SPSS) version 16.

RESULTS

The study revealed that most of the participants had high levels of academic burnout (163, 61.7%), emotional exhaustion (165, 62%), and disengagement (173, 65%). Moreover, academic burnout was significantly associated with age (χ²= 8.669, P = 0.012) and relaxation technique practice (χ²= 9.263, P = 0.002). Additionally, disengagement was significantly associated with gender (χ²= 9.956, P = 0.002), residence location (χ²= 7.032, P = 0.027), and relaxation technique practice (χ²= 8.729, P = 0.003).

CONCLUSIONS

Based on the findings of the study, we recommend that the faculty and administrators of nursing institutes must incorporate strategies for the prevention or reduction of academic burnout in the nursing curriculum.

Experiences of burnout, anxiety, and empathy among health profession students in Qatar University during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The prevalence of burnout and anxiety is constantly increasing among health profession students worldwide. This study evaluates the prevalence of burnout and its relationship to anxiety and empathy during the COVID-19 pandemic among health profession students in the main governmental institution in Doha, Qatar using validated instruments.

METHODS

A cross-sectional survey of health profession students using validated instruments was employed. The Maslach Burnout Inventory-General Students Survey (MBI-GS(S)) to measure burnout; The Generalized Anxiety Disorder (GAD-7) to measure anxiety; and Interpersonal Reactivity Index (IRI) to measure empathy were utilized. Descriptive statistics and multivariable linear regression were used.

RESULTS

Of the 1268 eligible students, 272 (21.5%) completed the online survey. Burnout was found to be prevalent amongst the students. The mean scores for the MBI-GS(S) subscales of emotional exhaustion, cynicism, and professional efficacy were 4.07, 2.63, and 3.97, respectively. Anxiety was found to be a strong predictor for burnout and burnout was positively associated with empathy.

CONCLUSIONS

Findings from this study demonstrated relationships between health profession students' burnout, anxiety, and empathy. These findings might have an impact on the development of curriculum interventions to enhance student well-being. More burnout awareness and management programs that cater to the specific needs of health profession students are needed. Furthermore, findings of this study may have implications for future educational interventions during times of crisis or how this can be used to improve student experiences in normal times.

Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students

AIM

The purpose of this study was to examine active listening, self-awareness, and empathy and how they relate to changes in patient-centered care (PCC) in undergraduate nursing students.

BACKGROUND

PCC is associated with better patient outcomes, but the level of PCC has been found to be low in nursing students.

METHOD

This secondary analysis used baseline and follow-up data at two time points from 50 undergraduate nursing students.

RESULTS

Changes in self-awareness were associated with changes in PCC directly (Follow-Up 1) or directly and indirectly through the effects on changes in empathy (Follow-Up 2), controlling for age, experience, and intervention. Changes in active listening were associated with changes in PCC only indirectly through the effect on changes in empathy only at Follow-Up 2.

CONCLUSION

Changes in self-awareness and active listening need to be the first targets of interventions to improve PCC in undergraduate nursing students.

Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center

OBJECTIVE

The healthcare workers in pediatric liver transplantation units are exposed to various stresses; however, their burnout has not been clarified yet. This study aimed to determine burnout, psychological symptoms and empathy levels in healthcare workers, to examine the relationship between these variables and to investigate the predictors of burnout.

METHOD

This cross-sectional study was conducted on healthcare workers in Turgut Özal Medical Center Pediatric Liver Transplant Institute. The participants filled out a questionnaire that investigating demographic and occupational characteristics, and including questions from Toronto Empathy Questionnaire, Maslach Burnout Inventory, and Brief Symptom Inventory.

RESULTS

Fifty healthcare workers participated in the study. Based on moderate and higher severity scores, 48% of the participants were emotionally exhausted, 22% of them were depersonalized. All of them had a high perception of personal accomplishment. There was a correlation between psychological symptoms level and emotional exhaustion and personal accomplishment as well as empathy and personal accomplishment. Not choosing the profession and the department willingly, age, education level, marital status, duration of profession, unit, not receiving in-service training, empathy, depressive symptoms and hostility scores predicted different aspects of burnout.

CONCLUSION

Considering that burnout and psychological stress lead to reduced professional abilities and the development of serious complications, the results obtained can guide managers on the measures to be taken.

Prevalence and associated factors of burnout among nursing students: A systematic review and meta-analysis

OBJECTIVES

To systematically estimate the global prevalence of burnout among nursing students, and examine the associated factors of burnout in this population.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

PubMed, Embase, Web of Science, and CINAHL were searched from inception to June 30th, 2022. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the global prevalence of burnout among nursing students. Subgroup analysis, meta-regression analysis, publication bias, and sensitivity analysis were also conducted.

RESULTS

A total of 21 studies were included, involving 10,861 nursing students. In the random-effects model, the pooled prevalence of burnout was 23.0 % (95 % CI = 15.6-30.5 %) in nursing students. The pooled prevalence of emotional exhaustion, depersonalization, and reduced personal accomplishment was 47.1 %, 32.2 %, and 43.5 %, respectively. Main associated factors of burnout included demographic (e.g., age and grade), educational (e.g., workload, academic satisfaction, and incivility experience), physical (e.g., sleep quality and physical activity), and psychological (e.g., self-efficacy and personality traits) factors.

CONCLUSIONS

Burnout is common in nursing students, with demographic, educational, physical, and psychological factors affecting their burnout. Early screening of burnout and interventions to prevent and reduce burnout should be considered for nursing students.

Factors related to the appearance and development of burnout in nursing students: a systematic review and meta-analysis

Introduction

Burnout may be suffered not only by experienced nurses, but also by those in training. The university environment can be highly stressful for student nurses, who are exposed to various stress-producing situations.

Aim

The aim of this study is to identify and analyse the main risk factors for burnout among nursing students.

Methods

A systematic review with meta-analysis was performed. The search equation used was "Burnout AND Nursing students". Quantitative primary studies on burnout in nursing students, and related risk factors published in English or Spanish and with no restriction by year of publication were included.

Results

A sample of n = 33 studies were included. Three variables are identified can influence burnout in nursing students: academic, interpersonal, environmental and/or social factors. The meta-analyses, with the higher sample of n = 418 nursing students, show that some personality factors, empathy, and resilience are correlated with emotional exhaustion, depersonalization and personal accomplishment.

Conclusion

The personality factors that can influence the development of burnout in nursing students, such as resilience and empathy, among others, must be taken into account when preventing the appearance and treating burnout. Professors should teach nursing students to prevent and recognize the most frequent symptoms of burnout syndrome.

Academic burnout, self-esteem, coping with stress and gratitude among Polish medical students – a cross sectional study

Introduction: Academic burnout is emerging as an essential obstacle in education process. Students of the most challenging fields of study with high degrees of stress are thought to be at the highest risk. Medical studies are considered one of them. The aim of the study was to measure the levels of academic burnout, stress and gratitude among Polish medical students of Medical University of Lublin, and determine their styles of coping with stress.

Materials and methods: A cross-sectional study was conducted using a questionnaire comprised of the following: Maslach Burnout Inventory – Student Survey (MBI-SS), Rosenberg Self-Esteem Scale (SES), a Coping Inventory for Stressful Situations (CISS) and a Gratitude Questionnaire Six-Item form (GQ-6). The data was obtained from 773 medical students.

Results: Total number of 169 students (21.86%) met criteria for academic burnout. When it comes to 354 participants, they displayed signs of low self-esteem (45.8%). The number of 18 students showed low level of gratitude, while gratitude level of the majority of them – 496 (64.17%) was high. The most common style of coping with stress was emotions-oriented style – 354 students (48.29%), followed by task-oriented style – 345 students (47.07%). Burnout subscales turned out to be associated with age, year of study, self-esteem, gratitude and different styles of coping with stress to the various extent.

Conclusions: The prevalence of academic burnout among Polish medical students is high compared with general population across various occupations. Utilisation of protective characteristics of high self-esteem, gratitude and healthy coping methods can result in development of efficient anti-burnout prevention strategies and intervention tools.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis

AIM

To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students.

DESIGN

This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students.

METHODS

We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed.

RESULTS

The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout.

CONCLUSION

The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification.

IMPACT

Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Burnout in International Medical Students: Characterization of Professionalism and Loneliness as Predictive Factors of Burnout

BACKGROUND

Burnout is a common mental problem in medical students. For those who are following medical studies abroad there is a higher risk of suffering this syndrome, due to the combination of academic stress and the stress derived from their new living situation. This study was performed with the purpose of testing the following hypothesis: in medical students enrolled in medical programs abroad, abilities associated with professionalism and family support play a protective role in the prevention of suffering burnout.

METHODS

A cross-sectional study was performed in the Faculty of Medicine of the University of Zagreb, where a fully English medical program is offered. The general version of the Maslach Burnout Inventory (MBI-GS) was used as a dependent variable, while Jefferson Scales of empathy, teamwork, and physician lifelong learning and the Social and Emotional Loneliness Scale for Adults were used as predictive variables. In addition, information related to sex, country of birth, native language, age, academic achievement, and living situation were collected in a socio-demographic form. Linear regression models were applied to identify predictors of burnout.

RESULTS

In a sample composed of 188 medical students (38 Croatians and 144 foreigners from 28 countries), 18% of the global score in the MBI-GS was explained by lifelong learning and family loneliness. A separate analysis for each domain of the MBI-GS allowed the creation of three models: the first model explained 19% of the variance of the "exhaustion" domain by "country of birth", "living with parents", "academic year", and "cynicism"; a second model explained 24% of the variance of the "cynicism" domain by "academic year", "empathy", "lifelong learning", and "exhaustion"; and finally, a third model explained 24% of the variance of the "professional efficacy" domain by "lifelong learning", "family loneliness", and "cynicism". All obtained models presented an effect size between medium and large, as well as matching the required conditions for statistical inference.

CONCLUSIONS

These findings confirm the important role that family plays as a source of support for medical students. Empathy and lifelong learning, two specific elements of medical professionalism, appear as protective factors in the prevention of burnout in international students.

Empathy, Burnout, and Attitudes towards Mental Illness among Spanish Mental Health Nurses

Mental health nurses, together with psychiatrists, are the healthcare professionals who display the highest levels of empathy and the best attitudes towards patients with mental disorders. However, burnout is a common problem among these professionals. The aim of our study is to describe the association between empathy, burnout, and attitudes towards patients with mental disorders among mental health nurses in Spain. A descriptive cross-sectional design was used involving a sample of 750 specialist nurses working in mental health facilities in Spain. An intentional, non-probability, non-discriminative, exponential snowball sampling method was used. The Jefferson Scale of Empathy, the Maslach Burnout Inventory, and the Community Attitudes towards Mental Illness Inventory were used to measure the study variables. A positive correlation was observed between empathy and all the study variables, with the exception of the personal accomplishment dimension of burnout and the social restrictiveness and authoritarianism dimensions of attitudes towards mental illness, where a negative relation was observed. Our findings suggest that empathy is associated with an increase in positive attitudes towards patients with mental disorders, decreasing associated stigma, but did not act as a protective factor against burnout in the study sample.

Prevalence of burnout among university students in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Burnout is common among university students and may adversely affect academic performance. Little is known about the true burden of this preventable malady among university students in low-and-middle-income countries (LMICs).

OBJECTIVES

This study aimed to systematically estimate the prevalence of burnout among university students in LMICs.

METHODS

We searched PubMed, Google Scholar, CINAHL, Web of Science, African Journals Online, and Embase from the inception of each database until February 2021. Original studies were included. No study design or language restrictions were applied. A random-effects meta-analysis was performed using STATA version 16.0. Heterogeneity and publication bias were assessed using Q-statistics and funnel plots, respectively.

RESULTS

Fifty-five unique articles, including a total of 27,940 (Female: 16,215, 58.0%) university students from 24 LMICs were included. The Maslach Burnout Inventory (MBI) was used in 43 studies (78.2%). The pooled prevalence of burnout was 12.1% (95% Confidence Interval (CI) 11.9-12.3; I2 = 99.7%, Q = 21,464.1, p = < 0.001). The pooled prevalence of emotional exhaustion (feelings of energy depletion), cynicism (negativism), and reduced professional efficacy were, 27.8% (95% CI 27.4-28.3; I2 = 98.17%. p = <0.001), 32.6 (95% CI: 32.0-33.1; I2: 99.5%; p = < 0.001), and 29.9% (95% CI: 28.8-30.9; I2: 98.1%; p = < 0.001), respectively.

CONCLUSION

Nearly one-third of university students in LMICs experience burnout. More studies are needed to understand the causes of burnout in this key population. There is a need to validate freely available tools for use in these countries.

Stress and quality of life of intensive care nurses during the COVID-19 pandemic: Self-efficacy and resilience as resources

Background

Health care workers employed in the COVID‐19 emergency are at a high risk of stress.

Aims and objectives

To explore the mediating roles of self‐efficacy and resilience between stress and both physical and mental quality‐of‐life components in intensive care nurses during the COVID‐19 pandemic.

Design

Cross‐sectional survey design.

Methods

The stress subscale (depression, anxiety, and stress scale in Spanish Scale, DASS‐21), the summary components (physical and mental) of health‐related quality of life (SF‐36), the general self‐efficacy scale (GSES), and the resilience scale (RS‐14) were administered in 308 intensive care nurses. Serial multiple mediator models were used.

Results

There was a significant indirect effect of levels of perceived stress on both physical and mental health components through self‐efficacy and resilience. Specifically, greater perception of self‐efficacy was associated with a lower perception of stress and greater resilience, while higher resilience was associated with greater physical and mental health (B = −0.03; SE = 0.02; 95% confidence interval [CI] = [−0.07, −0.01]; B = −0.03, SE = 0.01, 95% CI = [−0.07, −0.01], respectively). It was observed that self‐efficacy alone also mediates the relationship of the perception of stress on the components of physical and mental health (B = −0.07; SE = 0.05; 95% CI = [−0.18, −0.03]; B = −0.09; SE = 0.04; 95% CI = [−0.17, −0.24], respectively). However, resilience alone was not a significant mediator of these associations.

Conclusions

It can be concluded that stress is linked to the physical and mental health components related to quality of life through self‐efficacy and resilience.

Relevance to clinical practice

These psychological resources would allow the nursing staff to maintain a good quality of life despite high levels of stress. These findings have implications for future research in terms of both model testing and clinical application.