Meeting the challenges of stress and burnout in the intensive care and the emergency departments

Abstract

Doctors and nurses working at the accident and emergency department and the intensive care unit are exposed to burnout more than other health care professionals. They are required to spend considerate time in intense interaction with other people. This interaction is centered on the patient health problems (physical, psychological and social) and therefore, this interaction is saturated with diversity of feelings such as anger, anxiety and frustration because the solutions of patient's problems are not always accessible and attainable. These situations encountered by doctors and nurses increase the level of work stress. This stress will be built up to the point of burnout. Burnout according to Maslach is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who do people work of some kind. The purpose of this study was to determine the relationships and differences between work stressors, burnout and stress coping mechanisms among doctors and nurses at the accident and emergency department and at the intensive care unit. A quantitative design using the survey approach was used to collect data from participants. Data collected included demographics and responses to these instruments: 1) the adapted Nursing Stress Scale, 2) the Maslach Burnout Inventory and 3) the Coping Inventory for Stressful Situations. The sample consisted of a total population of 200 participants with a response rate of 71 % (n=154). Findings reported that work stressors were related to burnout in doctors and nurses at the accident and emergency department and the intensive care unit. Specifically, inadequate preparation was most strongly correlated with emotional exhaustion with a correlation coefficient of .38 (p=.01). Emotion oriented coping was significantly positively correlated with all the variables in the adapted nursing stress scale and the three burnout variables. Death and dying was most strongly correlated with emotion oriented coping with a correlation coefficient of .47 (p=.01). Emotional oriented coping was significantly positively related to emotional exhaustion (r=.30, p=.01). Doctors and nurses working at the accident and emergency department and in the intensive care unit all scored highest in relation to workload (M=1.8, SD=0.5).

Nurses experienced greatest stress (M=1.5, SD=O.4) than doctors (M=1.2, SD=O.4) in all the work stress variables. The study sample obtained overall average scores for emotional exhaustion (M=23.2, SD=11.9) and depersonalisation (M=8.9, SD=6.3) but high scores for personal accomplishment (M=32.3, SD=8.2). Doctors and nurses working at the accident and emergency department reported statistically higher degree of burnout when compared to doctors and nurses at the intensive care unit. The most frequently used coping strategy was reported to be avoidance oriented coping (M=2.8, SD=.82) and the least frequently used was task oriented coping (M=2.3, SD=.64). Emotion oriented coping was the only stress coping mechanism that was significantly different amongst doctors and nurses at the intensive care and the accident and emergency department. This study provides evidence of experienced stress and burnout by both doctors and nurses within the accident and emergency department and the intensive care unit. In an attempt to reduce stress in such environments the main recommendations were to have adequate staffing, supportive management, stress management programmes and improve in communication between doctors and nurses.