Maslach Burnout Inventory: factor structure and norms for British nursing staff

Development of the social burnout scale for college students

Although fruitful achievements have been explored about job burnout, little is known about burnout in the field of social interaction among college students. To address this limitation, this study defined the concept of Social Burnout and developed a measurement tool for it. The study adopted the method of combining qualitative research with quantitative research. After the qualitative study, we gathered examples of social burnout and finished item writing. Using convenient sampling and theoretical sampling methods, six different samples were recruited for reliability and validity testing. Confirmatory factor analysis (CFA) revealed the scale's two-factor structure: emotional exhaustion and depersonalization. Cronbach's alpha measured the internal consistency of the social burnout scale (SBS), which was excellent (Cronbach's alpha of emotional exhaustion = 0.94; depersonalization = 0.82; the overall = 0.92). Susequently, the method of calculating AVE and CR evaluated the scale's convergent and discriminant validity, which were relatively good (AVE of emotional exhaustion = 0.60, depersonalization = 0.59; CR of emotional exhaustion = 0.93, depersonalization = 0.81). Then, regression analysis verified the nomological network and criterion-related validity (r = -0.30, p < 0.01; r = -0.39, p < 0.01; β = -0.25, p < 0.01). The SBS was shown to be a reliable and appropriate measure for assessing students' social burnout. Furthermore, the SBS is recommended for use in academic research and by healthcare professionals to measure students' social distress. Further validation studies of this scale are needed in other cultural contexts.

Conditions of Nursing Practice in Hospitals and Nursing Homes Before COVID-19: Implications for Policy Action

Background

The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions.

Purpose

To describe registered nurses’ (RNs’) working conditions, job outcomes, and measures of patient safety and care quality in hospitals and nursing homes just before the pandemic.

Methods

Cross-sectional study using descriptive statistics to analyze survey data from RNs in New York and Illinois collected December 2019 through February 2020.

Results

A total of 33,462 RNs were included in the final analysis. Before the pandemic, more than 40% of RNs reported high burnout, one in four were dissatisfied with their job, and one in five planned to leave their employer within 1 year. Among nursing home RNs, one in three planned to leave their employer. RNs reported poor working conditions characterized by not having enough staff (56%), administrators who did not listen/respond to RNs’ concerns (42%), frequently missed nursing care (ranging from 8% to 34% depending on the nursing task in question), work that was interrupted or delayed by insufficient staff (88%), and performing non-nursing tasks (82%). Most RNs (68%) rated care quality at their workplace as less than excellent, and 41% gave their hospital an unfavorable patient safety rating.

Conclusion

Hospitals and nursing homes were understaffed before the COVID-19 pandemic, and many RNs were dissatisfied with their employers’ contribution to the widespread observed shortage of nursing care during the pandemic. Policy interventions to address understaffing include the implementation of safe nurse staffing standards and passage of the Nurse Licensure Compact to permit RNs to move expeditiously to locales with the greatest needs.

Serial-Multiple Mediation of Job Burnout and Fatigue in the Relationship Between Sickness Presenteeism and Productivity Loss in Nurses: A Multicenter Cross-Sectional Study

Background:

In China, sickness presenteeism, job burnout, and fatigue are common among nurses during the COVID-19 pandemic. We propose the prevalence of sickness presenteeism can adversely affect nurses' physical and mental health, negatively impact their work productivity and quality, and pose a threat to patients' safety. Therefore, this study examines the mechanism of productivity loss caused by sickness presenteeism, fatigue, and job burnout.

Objectives:

To investigate the serial-multiple mediating effect of job burnout and fatigue in the relationship between sickness presenteeism and productivity loss among nurses.

Methods:

A multicenter cross-sectional survey was undertaken by administering an online questionnaire from December 2020 to May 2021. Stratified cluster sampling was used to include 3,491 nurses from 14 hospitals in Shandong Province, China. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Chalder Fatigue Scale, and Maslach Burnout Inventory. Data analyses were carried out using descriptive statistics, one-way analysis of variance, independent-samples t-test, Pearson correlation analysis, hierarchical regression, and bootstrapping method.

Results:

From the 3,491 nurses who volunteered in this online survey, only 2,968 valid questionnaires were returned. Sickness presenteeism exhibited a prevalence of 70.6% during the COVID-19 pandemic. The average score of health-related productivity loss was 15.05 ± 4.52, fatigue was 8.48 ± 3.40, and job burnout was 39.14 ± 19.64. Sickness presenteeism was positively associated with fatigue and job burnout while job burnout was positively associated with nurse fatigue. Sickness presenteeism, fatigue, and job burnout were also positively correlated with health-related productivity loss. Statistically significant paths via the single mediation of fatigue and job burnout were established. A statistically significant serial-multiple mediating effect of fatigue and job burnout on the association between sickness presenteeism and productivity loss accounted for 35.12% of the total effect size.

Conclusions:

There was a high incidence of sickness presenteeism and job burnout among Chinese nurses. High-frequency sickness presenteeism may result in increased productivity loss through the two mediating effects of fatigue and job burnout. Sickness presenteeism may increase fatigue, promote job burnout, and result in increased productivity loss among Chinese nurses during the COVID-19 pandemic.

Reassessing the most popularly suggested measurement models and measurement invariance of the Maslach Burnout Inventory - human service survey among Vietnamese healthcare professionals

BACKGROUND

Despite its popularity, Maslach Burnout Inventory-Human Service Survey (MBI-HSS)'s factorial structure has been subject to considerable debate, and its measurement invariance (MI) is seldomly examined. This cross-sectional study aims at reassessing the most popularly suggested structures of this instrument, namely the 20- and 22-item three-factor model on Vietnamese healthcare professionals. It also examines the MI of MBI-HSS across genders, occupations, and mental health conditions.

METHOD

Self-administered questionnaires were sent out to 1500 doctors and nurses working at 15 hospitals in big cities in Vietnam in September and October 2020, and 1162 valid questionnaires were collected. The questionnaire consists of three sets of questions covering (1) demographic information of participants; (2) MBI-HSS questionnaire; and (3) The 21-item version of the Depression-Anxiety-Stress Scale. MBI-HSS scale was validated on Vietnamese sample for the first time; therefore, we used the repeated forward-backward procedure to translate this scale into Vietnamese. To examine which model best fits the data, a series of Confirmatory Factor Analysis (CFA) was used to test the model fit of correlated three-factor model, second-order hierarchical model, and bi-factor model. The reliability of the MBI-HSS was assessed using Cronbach's α coefficients. Then, multiple-group CFA (MGCFA) was applied to determine whether the MBI-HSS has a similar structure between groups different in gender, occupation, and mental health condition.

RESULTS

Our findings confirmed that the 22-item MBI-HSS best fit the data, and this scale measures three distinct but related aspects of burnout, including Emotional Exhaustion, Depersonalization, and Personal Accomplishment. The MI of MBI-HSS across genders and occupations was also confirmed. However, data did not fit well with group at risk for common mental health disorders. It can be concluded that the Vietnamese version of MBI-HSS is a valid measure to assess burnout level of healthcare professionals in Vietnam who are not at risk for mental health disorders.

Measurement Invariance of the Burnout Assessment Tool (BAT) Across Seven Cross-National Representative Samples

The aim of this study was to investigate the measurement invariance of the Burnout Assessment Tool (BAT) across seven cross-national representative samples. In this study, burnout was modeled as a second-order factor in line with the conceptual definition as a syndrome. The combined sample consisted of 10,138 participants from countries in Europe and Japan. The data were treated as ordered categorical in nature and a series of models were tested to find evidence for invariance. Specifically, theta parameterization was used in conjunction with the weighted least squares (mean- and variance adjusted) estimation method. The results showed supportive evidence that BAT-assessed burnout was invariant across the samples, so that cross-country comparison would be justifiable. Comparison of effect sizes of the latent means between countries showed that Japan had a significantly higher score on overall burnout and all the first-order factors compared to the European countries. The European countries all scored similarly on overall burnout with no significant difference but for some minor differences in first-order factors between some of the European countries. All in all, the analyses of the data provided evidence that the BAT is invariant across the countries for meaningful comparisons of burnout scores.

Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial

BACKGROUND

Many people with dementia living in care homes have distressing and costly agitation symptoms. Interventions should be efficacious, scalable, and feasible.

METHODS

We did a parallel-group, cluster-randomised controlled trial in 20 care homes across England. Care homes were eligible if they had 17 residents or more with dementia, agreed to mandatory training for all eligible staff and the implementation of plans, and more than 60% of eligible staff agreed to participate. Staff were eligible if they worked during the day providing face-to-face care for residents with dementia. Residents were eligible if they had a known dementia diagnosis or scored positive on screening with the Noticeable Problems Checklist. A statistician independent of the study randomised care homes (1:1) to the Managing Agitation and Raising Quality of Life (MARQUE) intervention or treatment as usual (TAU) using computer-generated randomisation in blocks of two, stratified by type of home (residential or nursing). Care home staff were not masked to the intervention but were asked not to inform assessors. Residents with dementia, family carers, outcome assessors, statisticians, and health economists were masked to allocation until the data were analysed. MARQUE is an evidence-based manualised intervention, delivered by supervised graduate psychologists to staff in six interactive sessions. The primary outcome was agitation score at 8 months, measured using the Cohen-Mansfield Agitation Inventory (CMAI). Analysis of the primary outcome was done in the modified intention-to-treat population, which included all randomly assigned residents for whom CMAI data was available at 8 months. Mortality was assessed in all randomly assigned residents. This study is registered with the ISRCTN registry, number ISRCTN96745365.

FINDINGS

Between June 14, 2016, and July 4, 2017, we randomised ten care homes (189 residents) to the MARQUE intervention and ten care homes (215 residents) to TAU. At 8 months, primary outcome data were available for 155 residents in the MARQUE group and 163 residents in the TAU group. At 8 months, no significant differences in mean CMAI scores were identified between the MARQUE and TAU groups (adjusted difference -0·40 [95% CI -3·89 to 3·09; p=0·8226]). In the intervention care homes, 84% of all eligible staff completed all sessions. The mean difference in cost between the MARQUE and TAU groups was £204 (-215 to 623; p=0·320) and mean difference in quality-adjusted life-years was 0·015 (95% CI -0·004 to 0·034; p=0·127). At 8 months, 27 (14%) of 189 residents in the MARQUE group and 41 (19%) of 215 residents in the TAU group had died. The prescription of antipsychotic drugs was not significantly different between the MARQUE group and the TAU group (odds ratio 0·66; 95% CI 0·26 to 1·69, p=0·3880).

INTERPRETATION

The MARQUE intervention was not efficacious for agitation although feasible and cost-effective in terms of quality of life. Addressing agitation in care homes might require resourcing for delivery by professional staff of a more intensive intervention, implementing social and activity times, and a longer time to implement change.

FUNDING

UK Economic and Social Research Council and the National Institute of Health Research.

Do care homes deliver person-centred care? A cross-sectional survey of staff-reported abusive and positive behaviours towards residents from the MARQUE (Managing Agitation and Raising Quality of Life) English national care home survey

Background

There are widespread concerns about abuse of care home residents. We report, in the largest care home survey, prevalence of staff anonymously-reported, perpetrated/witnessed abusive behaviours towards care home residents over 3 months. We also report positive care behaviours.

Methods

1544 staff in 92 English care home units completed the revised Modified Conflict Tactics Scale and Maslach Burnout Inventory.

Outcomes

Most staff reported positive care behaviours, but specific person-centred activities were sometimes infrequent. Many care home staff were never or almost never aware of a resident being taken out of the home for their enjoyment (34%, n = 520); or an activity planned around a resident’s interests (15%, n = 234). 763 (51%; 95% Confidence Interval (CI) 47% to 54%) of care home staff reported carrying out or observing potentially abusive or neglectful behaviours at least sometimes in the preceding 3 months; some abuse was reported as happening “at least sometimes” in 91/92 care homes. Neglect was most frequently reported: making a resident wait for care (n = 399, 26%), avoiding a resident with challenging behaviour (n = 391, 25%), giving residents insufficient time for food (n = 297, 19%), and taking insufficient care when moving residents (n = 169, 11%). 1.1% of staff reported physical and 5% verbal abuse. More staff reported abusive/neglectful behaviour in homes with higher staff burnout-depersonalisation scores (adjusted odds ratio 1.191, CI 1.052–1.349).

Interpretation

Staff anonymous reports of abusive behaviour and neglect could be used to monitor care quality, as cases currently reported are probably tip of the iceberg, and be an outcome in intervention studies.

Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

BACKGROUND

Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.

OBJECTIVES

To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.

METHOD

Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).

RESULTS

The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.

CONCLUSION

Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Factor Structure of the Maslach Burnout Inventory–Educators Survey in a Polish-Speaking Sample

This article investigates the psychometric properties of a mainstream burnout measure dedicated to teachers: the Maslach Burnout Inventory–Educators Survey (MBI-ES). The study used data gathered from a random sample of 1,206 primary school teachers in Poland to verify the construct validity of the MBI-ES. Eight alternative measurement models suggested in the literature were tested using confirmatory factor analysis. Contrary to many previous studies, this study did not support the oblique three-factor structure of the MBI-ES. A bifactor model with one general Burnout factor and three specific orthogonal factors of personal accomplishment, depersonalization, and emotional exhaustion showed best fit to the data. Additional analyses supported the measure’s essential unidimensionality. The results yield theoretical implications for construct reconceptualization and practical guidelines for researchers and practitioners.

Burnout among Nurses

Results are presented of a cross-national study on burnout among 200 Polish and 183 Dutch female nurses. The reliablity and the factorial validity of the Maslach Burnout Inventory (MBI) is satisfactory in both countries. However, evidence for the content validity of the MBI is likewise equivocal in both samples. Polish nurses are significantly more burned out than their Dutch colleagues, even after controlling for differences in work situations in both countries. Subjective work stressors (i.e., uncertainty and a perceived imbalance between investments and outcomes in relationships with patients) contribute most strongly to bumout in Polish as well as in Dutch nurses. Personality characteristics and aspects of the work situation play a less prominent role. Although the work situation of Polish and Dutch nurses differs considerably, psychological variables-notably, experienced job stress-are likewise crucial in understanding burnout among nurses of both countries.

Burnout of registered nurses in South Africa

AIM

The aims of this study were to validate the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for registered nurses in South Africa and to analyse the differences between the levels of burnout of different biographical groups.

BACKGROUND

The nursing profession is seen as a stressful and emotionally demanding profession, which makes nurses susceptible to burnout.

METHOD

A cross-sectional survey design with a stratified random sample (n = 818) was used. The MBI-HSS and a biographical questionnaire were administered.

RESULTS

Exploratory factor analysis resulted in a three-factor structure of burnout, consisting of emotional exhaustion, depersonalization and personal accomplishment. Construct equivalence and reliability of the three factors were confirmed. Significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

CONCLUSIONS

The MBI-HSS showed acceptable validity and reliability for South African nurses. Burnout is associated with specific factors, including language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of the MBI-HSS is recommended to assess burnout of nurses in South Africa. Organisations employing nurses should intervene to prevent and/or manage burnout.

Symptoms of posttraumatic stress disorder among pediatric acute care nurses

In their work, pediatric acute care nurses may encounter traumatic events and be at risk for posttraumatic stress disorder (PTSD). This survey-based study examines the potential diagnosis of PTSD among nurses at a tertiary children's hospital with a Level 1 trauma center. Twenty-one percent of respondents had strong PTSD symptoms without significant difference between units. Nurses with potential PTSD had more comorbid symptoms of anxiety, depression, and burnout and were more often considering a career change. Furthermore, symptoms affected not only their work but also their personal lives. Future research should focus upon identifying pediatric nurses with PTSD to provide therapeutic interventions and reducing high-risk events and their potential impact.

Evaluation of the impact of a consultation in a secure setting

BACKGROUND

Organisational consultation is widespread in the National Health Service (NHS), but little is known about its impact.

AIMS

To evaluate the impact of a psychodynamically informed consultation to a high-security hospital ward.

METHOD

 This prospective study compared measures before and after the consultation with similarly timed measures on a comparison ward in the hospital, matched for patient characteristics, but not exposed to the consultation. The intention was to compare the consultation with 'treatment as usual', but the study became a comparison of interventions after a programme to facilitate staff-patient communication was instituted by management on the comparison ward. Measures included the Ward Atmosphere Scale (WAS) and an index of burnout. Interactions between staff and patients were observed and rated for content and quality.

RESULTS

 Most scales on two of three dimensions of the WAS improved on both wards, as did the quality of staff-patient contact. Change at the levels of behaviour and attitude strengthens confidence that a shift occurred in a positive direction.

CONCLUSIONS

 The overall importance of professional supportive attention to staff in such settings was established. Although there was little evidence here for a distinct advantage of one intervention style, the results were encouraging for the consultation, because ward atmosphere and staff-patient interaction were not a direct target for change. Further study is needed to test the possibility that specific interventions may carry specific advantage in other settings or with other patient groups. The nature and quality of institutional support for such research itself needs strengthening. In this case, the institutions' intention to assist was robust, but real understanding and/or sustained ability to facilitate it is lacking. This problem is hardly unique to this setting.

Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine

STUDY OBJECTIVE

Questions about burnout, career satisfaction, and longevity of emergency physicians have been raised but no studies have examined tolerance for uncertainty as a risk factor for burnout. Primary objectives of this study are to assess the role of uncertainty tolerance in predicting career burnout and to estimate the proportion of emergency physicians who exhibit high levels of career burnout.

METHODS

A mail survey incorporating validated measures of career satisfaction, tolerance for uncertainty, and burnout was sent to a random sample of members of the American College of Emergency Physicians. Best- and worst-case scenarios of point estimates are provided to assess for the effect of nonresponse bias, and multivariable logistic regression was used to predict evidence of career burnout.

RESULTS

One hundred ninety-three surveys were returned (response rate 43.1%). A high level of career burnout was exhibited in 62 (32.1%; best-worst case 13.8% to 64.1%) respondents. No demographic variables were associated with burnout status. The final model identified that high anxiety caused by concern for bad outcomes (odds ratio=6.35) was the strongest predictor of career burnout, controlling for all other variables.

CONCLUSION

A large percentage of emergency physicians in this study, 32.1%, exhibited emotional exhaustion, which is the core symptom of burnout. Emotional exhaustion was not related to age or type of practice and was not mitigated by training in emergency medicine. Physicians studied did not feel anxiety because of general uncertainty, difficulty in disclosing uncertainty to patients, or admitting errors to other physicians. High anxiety caused by concern for bad outcomes was the strongest predictor of burnout. Despite exhibiting emotional exhaustion, the majority of respondents are satisfied with the career of emergency medicine.

[A meta-analysis of job burnout using the MBI scale]

BACKGROUND AND AIM

The aim of this study was to investigate the theoretical dimensionality of burnout measurement (MBI). The objective of the study was to check the working hypothesis according to which the subscales of the Maslach Burnout Inventory (MBI) such as "emotional exhaustion" and "cynicism" (depersonalization) were not correlated with that of "personal achievement" (professional efficacy). To do so, we performed a meta-analysis [Maslach and Jackson, The Maslach Burnout Inventory, 1981, 1986].

METHODS

The sample included 12,112 participants (sample size range from 100-3312 participants; estimated mean=448.59; standard deviation=648.51). Doctheses, Francis, Interscience, Kluweronline, Medline, PsycInfo, and ScienceDirect were searched to identify papers. Exploring references identified 83 publications (1998-2001). Two keywords were used: "Maslach Burnout Inventory" and "organizational stress". The criteria for this meta-analysis included: using the MBI "human services survey (HSS)" for professional care givers, "educators' survey (ES)" for professional educators, "general survey (GS)" for other workers).

RESULTS

About 58% of the population concerned professional caregivers, 13% professional educators, 11% social workers, and 18% correctional officers and other workers. In this meta-analysis, effect sizes should be reported with the number of studies and confidence intervals to test the consistency and reliability of the mean estimated (effect size). In this case, each correlation can be corrected. The meta-analysis can therefore be conducted on this corrected correlation. The aim will be to control any artefact and sampling error. Meta-analysis showed that the value of the corrected correlation is not always negative in the case of a relation between the dimension of "emotional exhaustion" and "personal achievement" (professional efficacy). In the case of the dimension "emotional exhaustion" and "cynicism" (depersonalization), we observed that the value of the corrected correlation studies and confidence intervals showed that this dimension was always correlated positively in the studies included. For the relationship between the value of corrected correlation studies and confidence intervals of the dimension of "cynicism" (depersonalization) and "personal achievement" (professional efficacy), the studies included showed that they were always correlated negatively. These results confirm the hypothesis studied.

CONCLUSION

The study revealed two points: (1) the homogeneity of the studies included concerning the fact that assessment of emotional exhaustion and cynicism (depersonalization) are always correlated positively; (2) the heterogeneity of the studies included concerning the fact that personal achievement is correlated with the other subscales of burnout (MBI). This study confirms the hypothesis.

Factor structure of the Maslach Burnout Inventory among Finnish nursing staff

The purpose of the study was to investigate the factor structure of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) among Finnish nursing staff. Although the factorial validity of the MBI-HSS has been studied across different countries, the factor structure has never been investigated among Finnish nursing staff. The data were gathered by postal questionnaires from nursing staff working in health-care organizations around Finland. The sample consisted of 627 nurses and nurse managers. The factor structure was studied by using exploratory and confirmatory factor analysis. The fit of the hypothesized three-factor model to the data was superior to the alternative one-factor and two-factor models. The three-factor structure (emotional exhaustion, depersonalization, reduced personal accomplishment) showed the best fit, while the internal consistencies of the subscales were satisfactory. The MBI-HSS is a highly suitable instrument for measuring burnout among nursing staff and it is very applicable to Finnish health-care research.

The Effects of Mindfulness-based Stress Reduction on Nurse Stress and Burnout, Part II

This article is the second in a series reporting on research exploring the effects of Mindfulness-based Stress Reduction on nurses and describes the quantitative data. The third article describes qualitative data. Treatment group participants reduced scores on 2 of 3 subscales of the Maslach Burnout Inventory significantly more than wait-list controls; within-group comparisons for both groups pretreatment and posttreatment revealed similar findings. Changes were maintained as long as 3-month posttreatment. Implications of these findings are discussed.

The role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers

OBJECTIVE

This study examined the role of individual, interpersonal, and organizational factors in mitigating burnout among elderly Chinese volunteers in Hong Kong.

METHODS

A total of 295 elderly Chinese volunteers were individually interviewed on their demographic characteristics, voluntary service experience, physical health status, general self-efficacy, social support, satisfaction and perceived benefit from volunteer work, and burnout symptoms. Exploratory factor analysis was first performed to determine the underlying dimensions of burnout experience. Correlation analyses were then conducted to explore associations among major variables. Hierarchical regression analyses were also performed to unearth the relative contribution of various factors in predicting burnout among elderly volunteers.

RESULTS

A two-factor structure of burnout, namely lack of personal accomplishment and emotional depletion, was found. Demographics, individual, interpersonal, and organizational factors were significant predictors of lack of personal accomplishment. In particular, personal accomplishment was best predicted by a long duration of voluntary work service and high levels of self-efficacy, work satisfaction, and perceived benefit. For emotional depletion, only demographics and individual factors were significant predictors. A low level of emotional depletion was best predicted by older age, a short duration of voluntary work experience, and good health.

CONCLUSIONS

Burnout experience was evident among elderly Chinese volunteers. There were different predictors of affective and cognitive components of burnout. Findings have significant implications to attenuate burnout symptoms among elderly volunteers.

Stress in community care teams: will it affect the sustainability of community care?

The study investigated whether community care is sustainable by examining the levels of stress and burnout that affect community mental health staff. Six teams from around Great Britain were chosen to take part, representing a number of different facets of care: the type of community model, whether it was in an inner city or suburban area and whether the team had been part of a scientific evaluation of care, in which case it may have contained more experienced and more highly trained staff. The results indicated that community care staff experienced high levels of burnout as a result of the work stressors. These levels were higher than those found in any published study of health professionals within hospitals, but are similar to those found in community teams recently. There was no evidence that any particular model of community care produced less burnout, but working in an inner city did seem to produce the highest levels. There did seem to be some benefit from a moderate staff turnover within teams. These results mirror those of other recent studies. Models of community care can only be sustained by reducing their toxicity on the staff who have to make them work. Therefore, levels of stress and burnout should be included in any evaluation of the cost-effectiveness of service models. The alleviation of these high levels through individual and organisational interventions should now be a high priority.

The factor structure of the Maslach Burnout Inventory in two Swedish human service organizations

The Maslach Burnout Inventory, MBI, is a well established measure of burnout. Its validity outside the USA is, however, uncertain. The aim of the present study was therefore to apply the MBI on personnel in two Swedish human service organizations, comparing factor solutions and scoring norms to the original results. The population consisted of 5730 employees in the Social Insurance Organization (SIO) and the Individual and Family Care section (IFC) of the social welfare agencies. Principal components analysis, principal axes and alpha factor analyses were performed, all with varimax rotation. The suggested three factor solution showed to be remarkably stable irrespective of type of analysis. Score levels were somewhat lower on two subscales in the Swedish population. The conclusion is that the psychometric properties of the MBI seem to be very satisfactory and stable, at least in comparison between Sweden and USA. It is suggested that the dimensionality of MBI is rather invariant, but that the score levels covary with national, cultural, or professional contexts within the human services.

A cautionary note about the cross-national and clinical validity of cut-off points for the Maslach Burnout Inventory

In the present study, burnout scores of three samples, as measured with the Maslach Burnout Inventory, were compared: (1) the normative American sample from the test-manual (N = 10,067), (2) the normative Dutch sample (N = 3,892), and (3) a Dutch outpatient sample (N = 142). Generally, the highest burnout scores were found for the outpatient sample, followed by the American and Dutch normative samples, respectively. Slightly different patterns were noted for each of the three components. Probably sampling bias, i.e., the healthy worker effect, or cultural value patterns, i.e., femininity versus masculinity, might be responsible for the results. It is concluded that extreme caution is required when cut-off points are used to classify individuals by burnout scores; only nation-specific and clinically derived cut-off points should be employed.

The Maslach Burnout Inventory: Validating Factorial Structure and Invariance Across Intermediate, Secondary, and University Educators

The purposes of the study were: (a) to test for the factorial validity of the Maslach Burnout Inventory (MBI), for 543 teachers at the intermediate (n = 163), secondary (n = 162), and university (n = 218) levels, and (b) to test for the equivalence of factorial measurements and structure across groups. Initial confirmatory factor analysis of the hypothesized 3-factor structure yielded a malfitting model for each group of educators. With a view to improving the MBI for use with educators, subsequent exploratory and confirmatory factor analyses resulted in the deletion of four scale items. Tests for invariance revealed the equivalency of remaining items across intermediate and secondary teachers, and items measuring Emotional Exhaustion and Depersonalization across all three groups; the structure of burnout was only partially invariant across educators. The study has important implications for substantive studies focusing on multigroup comparisons across teaching panels.

Relationship between burnout and performance

This paper seeks to clarify the nature of the relationship between burnout and both perceived and actual performance. A sample was chosen for whom a clear and objective measure of actual performance was available. This was a group of 95 mid-career MBA students, for whom examination scores were obtained. A questionnaire containing items assessing burnout and perceived performance was administered. There were significant positive correlations between the measure of burnout and the items assessing perceived performance, particularly those reflecting self-esteem. There was no significant association between the measure of burnout and actual performance. It is suggested that (i) a clear distinction between actual and perceived performance be made in the burnout literature; (ii) it is premature to assume burnout will lead to an actual decline in performance; (iii) the notion of deteriorating perceived performance in relation to burnout may have more to do with general feelings of self-esteem than performance or accomplishment per se.

Maslach Burnout Inventory: factor structures and norms for USA pharmacists

This study was conducted to establish normative data as well as evaluate the construct validity and reliability of the three subscales of the Maslach Burnout Inventory when given to a national sample of USA licensed practicing pharmacists. Data were subjected to principal factors analysis with iteration and a varimax rotation to obtain a three-factor solution. Visual analysis and statistical comparison provided empirical support for the presence of the hypothesized (a priori) constructs of Emotional Exhaustion, Depersonalization, and Lack of Personal Accomplishment. Internal consistency of the derived subscales, as measured by Cronbach's alpha coefficient, were comparable with previous data. Pharmacists' subscale scores were significantly lower than those obtained in studies of the helping professions.

Personality hardiness, occupational stress, and burnout in critical care nurses

Personality hardiness, occupational stress, and burnout were investigated in 100 critical care nurses. Hardiness was predictive of occupational stress and burnout. Hierarchical multiple regressions revealed that one of the three dimensions of hardiness, commitment to work, was the only variable to account for significant amounts of variance (up to 24%) across three of four measures of burnout. The study did not provide support for the stress buffering effect of hardiness. That is, an interaction term, hardiness x occupational stress, was not convincingly predictive of burnout in nurses. The findings are discussed in terms of other research on burnout in critical care nurses and recent issues on the conceptualization of hardiness.

Professional depression, 'burnout' and personality in longstay nursing

Conceptualizations of 'burnout' vary between authors. Some descriptions of burnout show strong similarities to depression in the work setting, or 'professional depression' as described by Oswin [Children Living in Long Stay Hospitals, 1978. Heinemann, London]. This study supported such a similarity, and demonstrated a considerable extent of depressed mood amongst nursing staff in longstay settings, which was particularly significant amongst male staff. A number of distinct 'burnout' responses were evident amongst staff including not only 'professional depression' and depersonalization but also the avoidance of problems and decisions. Ambiguity about supervisors' expectations and success in meeting such expectations were associated with increased scores on each of these variables. Personality appeared to be related to staff's responses. Staff prone to direct hostility inwards on themselves were more likely to show an avoidance of problems and decisions. Those staff prone to direct hostility outwards were more likely to report an awareness of depersonalization toward others. Both these processes may in different ways affect patient care and relationships with other professionals.

Burnout and professional depression: related concepts?

In 1978 Oswin documented a process of 'professional depression' affecting some nursing staff in long-stay hospitals. This study tested the hypothesis that 'professional depression' in long-stay nursing and 'emotional exhaustion' as a component of burnout describe a similar phenomenon. This hypothesis was supported. The results are consistent with Cherniss' characterization of burnout, which appears to show considerable similarities to the concept of depression. In this study professional depression demonstrated a substantial correlation with depressed mood. Personality demonstrated significant relationships with burnout variables, extrapunitive hostility correlating with hardening toward others, intropunitiveness with avoidance as a coping response. These findings, although confined to hospital nurses, support the usefulness of approaches stressing the interaction between the work environment and the individual.