In our study, we find that burnout syndrome, post-traumatic stress disorder, depression, and anxiety are prevalent in nursing groups. The BOS has been thoroughly studied as it has a detrimental effect on nurses suffering from it by raising their absence and medical errors that have direct impact on patient safety in addition to its effect on the health institution itself [17, 18].
Our study shows that emotional exhaustion is the most affected aspect of BOS in nurses, being present in 73.5% of the sample. This is followed by personal accomplishment, which was found in 68.5% of the sample. The lowest level was depersonalization, which affected 61.9% of these nurses. This was in agreement with Elshaer et al. [19] who found that the most of the study subjects developed high emotional exhaustion scores (80%), while < 1/3 reported either high depersonalization or low personal accomplishment levels.
It is worthy to mention that the predominance of female nurses in our sample could add to the burden of stress at work place for them and this is in line with the study done in Ethiopia and found significantly association between sex and job stress [20]. Female nurses are more subjected to different sources of stress such as discrimination, stereotyping in addition to coordination between work, and marriage and family demands.
Among these 3 dimensions of BOS, ICU nurses had the highest prevalence compared to inpatient nurses in stressful areas (non-ICU), inpatient nurses (non-intensive care unit), and outpatient ones. This can be explained that ICU nurses encounter difficult patients facing life issues forcing them to meet daily challenges that add more pressure to their work.
These results are in concordance with the study of Gillespie and Melby [21] who studied BOS on nursing staff in accident, emergency, and acute medicine departments and reported the same results. Another study of the prevalence of BOS and PTSD in nurses at the University of Colorado Hospital revealed that the highest stress facing nurses were the patient’s death and seeing a patient suffer as death is usually linked to clinical failure [1].
From multitude of researches, 25–33% of ICU nurses develop severe BOS and approximately 86% have at least 1 symptom out of the 3 symptoms of BOS [22, 23, 28].
Another study done by Poncet et al. [24] on critical care nurses revealed severe BOS in 32.8% of participants similarly to the study of Verdon et al. [25] who reported that third of the critical care nurses developed BOS.
Nurses diagnosed with PTSD almost develop BOS, but the reverse is not always fulfilled, as just 19.49% of nurses with BOS were diagnosed with PTSD. These refer to the fact that nurses who develop PTSD will be vulnerable to BOS.
Also, the combination of both diagnosis of BOS and PTSD has significant relation with how the care received by the nurses is one of the key factors in the prognosis of the patient. Moreover, nurses without BOS and PTSD are elder and have more years of experience compared to those with both BOS and PTSD. Similarly, the analysis of job-related stress among nurses employed in Ethiopia correlated years the nurse had practiced and her age with the prevalence of PTSD [26]. This can be explained that the adaptation and coping of nurses become better and effective overtime.
In our study, 79% were positive for depression and 64.6% were positive for anxiety. These results are in concordance with a study of held in Australia that concluded that depression levels were predicted significantly by the level of stress nurses are exposed to [27].
Our study reveals that increasing age and experience act as a protective factors for burnout syndrome; this finding could be explained that nurses with more experience on their job may gain higher confidence about tasks they do, and may make relationships at work that are meaningful to them [28]. In coherence with these findings, Patrick and Lavery [29] reported that nurses who work longer duration on the job are more likely to have experienced almost all work scenarios. Another explanation could be that nurses in this sector have less working hours or their job nature changed with more on desk tasks than working closely to patients which lead to less burden on older nurses. In the present study, risk factors of burnout syndrome were lack of use of proactive coping and instrumental support seeking. These results are in concordance with a study on the relationship between proactive coping and the different three dimensions of burnout that found that nurses with a more proactive coping style had experienced less symptoms of burnout [30].
In the present study, lack of use of reflective coping and preventive coping was risk factors of both depression and anxiety, while defective avoidance coping and instrumental support seeking were risk factors of post-traumatic stress disorder .Overall proactive coping inventory scale is a predictor for burnout syndrome, post-traumatic stress disorder, depression, and anxiety. These findings are in concordance with a study on proactive coping and PTSD among nursing students in which regression analysis revealed that proactive coping was associated with lower levels of PTSD, depression, and anxiety [31]. In contrast to a Chinese study which reported that although the study participants had successful coping mechanisms, yet they had significant levels of stress and depression [32].
Proactive individuals often make efforts to plan in advanced manner that allow them more easily to overcome distress and challenging goals and to promote their personal growth [26]. Proactive individuals are considered future oriented and they know how to use their resources to face stressors before being emotionally exhausted. So, they are more likely to set up resources that serve as buffers against stress and are less likely to accumulate stress to a level that cannot be handled.
