Burnout and its influencing factors between frontline nurses and nurses from other wards during the outbreak of Coronavirus Disease -COVID-19- in Iran
Keywords:Burnout, psychological, nurses, coronavirus infections;, risk factors, pandemics, cross-sectional studies
Objective. To assess burnout level during an outbreak of COVID-19 and to identify influencing factors between frontline nurses and nurses from other wards.
Methods. This cross-sectional study makes comparison between two groups of nurses including frontline (exposure group) and other nurses working in usual wards (non-exposure group) in Torbat Heydariyeh city, Iran. Oldenburg Burnout Inventory (OLBI), Job stress questionnaire (JSQ), and questionnaires of hospital resources, family support, and measuring the fear of COVID-19 were used as research instruments.
Results. The scores of job stress and burnout in the exposure group with COVID-19 infection were significantly higher than in the non-exposure group (p=0.006 and p=0.002, respectively). Although, in univariate linear regression, employment status (p=0.047), experience in taking care of patient confirmed or suspected with COVID-19 infection (p=0.006), hospital resources (p=0.047), and job stress (p<0.001) were considered as significant risk factors for COVID-19-related burnout. In multivariate regression analysis, job stress (p=0.031, β=0.308) was considered as an only factor that has a significant relationship with COVID-19-related burnout.
Conclusion. The burnout level in frontline nurses was higher than other nurses, the most important influencing factor was the job stress. Regarding to negative effects of burnout on both physical and mental health nurses, it is suggested that a strong strategy be considered to reduce nurses' burnout to be able to control ongoing and future outbreaks successfully.
coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil. Med. Res. 2020; 7(1):11.
2. Fong SJ, Li G, Dey N, Crespo RG, Herrera-Viedma E. Finding an accurate early forecasting model from small dataset: A
case of 2019-ncov novel coronavirus outbreak. Int. J. Interact. Multimed. Artif. Intell. 2020: 132-4.
3. Shang W, Yang Y, Rao Y, Rao X. The outbreak of SARS-CoV-2 pneumonia calls for viral vaccines. npj Vaccines. 2020;
4. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 70 [Internet]. Geneve: WHO;
2020 [Cited 29 May 2020]. Available from: https://www.who.int/docs/default-source/coronaviruse/situationreports/20200330-sitrep-70-covid-19.pdf?sfvrsn=7e0fe3f8_4
5. World Health Organization. Advice on the Use of Masks the Community, during Home Care and in Health Care Settings
in the Context of the Novel Coronavirus (2019-nCoV) Outbreak Interim Guidance [Internet]. Geneve: WHO; 2020 [Cited
29 May 2020]. Available from: https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-communityduring-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
6. Constable JF, Russell DW. The effect of social support and the work environment upon burnout among nurses. Journal
of human stress. 1986; 12(1):20-6.
7. Lee H, Cummings GG. Factors influencing job satisfaction of front-line nurse managers: a systematic review. J. Nurs.
Manag. 2008; 16(7):768-83.
8. Cocchiara RA, Peruzzo M, Mannocci A, Ottolenghi L, Villari P, Polimeni A, et al. The use of yoga to manage stress and
burnout in healthcare workers: A systematic review. J. Clin. Med. 2019; 8(3):284.
9. Bentz L, Pirard P, Motreff Y, Vandentorren S, Baubet T, Fabre R, et al. Health outcomes of the July 14, 2016 Nice terror
attack among hospital-based professionals and students: the «ECHOS de Nice» health survey protocol. BMC Public
Health. 2019; 19(1):1163.
10. Kim JS, Choi JS. Factors influencing emergency nurses’ burnout during an outbreak of Middle East Respiratory Syndrome
Coronavirus in Korea. Asian Nurs. Res. 2016; 10(4):295-9.
11. Demerouti E, Bakker AB, Vardakou I, Kantas A. The convergent validity of two burnout instruments: A multitraitmultimethod analysis. Eur. J. Psychol. Assess. 2003; 19(1):12-23.
12. Sinval J, Queirós C, Pasian S, Marôco J. Transcultural adaptation of the Oldenburg burnout inventory (OLBI) for Brazil
and Portugal. Front. Psychol. 2019; 10:338.
13. Larki M, Ghaffari M, Baezzat F. The effort-reward imbalance theory and measurement of stress in academic context:
Construction and validation of student version of the Effort-Reward Imbalance Questionnaire (ERIQ-S). Occupational
Medicine Quarterly Journal. 2018;10(2):72-83.
14. Parker DF, DeCotiis TA. Organizational determinants of job stress. Organ. Behav. Hum. Performance.1983; 32(2):160-
15. Iraji M, Sohrabi N. Determination of Differences in Emotion Regulation Strategies, Occupational Stress Management, and
Degree of Workaholism among General Surgery Residents. Sadra Med. Sci J. 2016; 4(2):107-16.
16. Shiao JS-C, Koh D, Lo L-H, Lim M-K, Guo YL. Factors predicting nurses’ consideration of leaving their job during the
SARS outbreak. Nurs. Ethics. 2007; 14(1):5-17.
17. Tzeng H-M, Yin C-Y. Nurses’ fears and professional obligations concerning possible human-to-human avian flu. Nurs.
18. Hunsaker S, Chen HC, Maughan D, Heaston S. Factors that influence the development of compassion fatigue,
burnout, and compassion satisfaction in emergency department nurses. J. Nurs. Scholarsh. 2015; 47(2):186-94.
19. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan for
fighting against the COVID-19 epidemic. J. Nurs. Manage. 2020; doi: 10.1111/jonm.13014.
20. Stimpfel AW, Sloane DM, Aiken LH. The longer the shifts for hospital nurses, the higher the levels of burnout and
patient dissatisfaction. Health Affairs. 2012; 31(11):2501-9.
21. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil. Nurs. 2014; 39(1):16-25.
22. Sarafis P, Rousaki E, Tsounis A, Malliarou M, Lahana L, Bamidis P, et al. The impact of occupational stress on nurses’
caring behaviors and their health related quality of life. BMC Nurs. 2016; 15(1):56.
23. Sasangohar F, Jones SL, Masud FN, Vahidy FS, Kash BA. Provider Burnout and Fatigue During the COVID-19
Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Anesth. Analg. 2020; doi:10.1213/
24. Wu Y, Wang J, Luo C, Hu S, Lin X, Anderson AE, et al. A comparison of burnout frequency among oncology physicians
and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J. Pain
Symptom Manage. 2020; S0885-3924(20)30205-0.
25. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting
nurses’ coping strategies during the SARS crisis: an online questionnaire survey. Int. J. Nurs. Stud. 2007; 44(6):991-8.
26. Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and
occupational effects of providing hospital healthcare during SARS outbreak. Emerg. Infect. Dis. 2006; 12(12):1924-32.
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