Stress-related Psychological Disorders Among Surgical Care Nurses ...

Review of Global Medicine and Healthcare Research

Volume 2 Number 2 (2011) Publisher: DRUNPP Managed by: IOMC Group ISSN: 1986-5872

Website: www.iomcworld.com/rgmhr/

REVIEW OF GLOBAL MEDICINE AND HEALTHCARE RESEARCH (RGMHR) ISSN: 1986-5872

Stress-related Psychological Disorders Among Surgical Care Nurses in Latvia Kristaps Circenis *, Inga Millere, Liana Deklava Riga Stradiņš University, Faculty of Nursing, Riga, Latvia * Corresponding author; Email: [email protected]

ABSTRACT Background: The subject of stress related psychological disorders is considered to be one of the most critical problems in the 21st century. Latvia’s social-economic situation is stressful and a lot of nurses still need to work more than one shift. There are no complete studies about surgical care nurses and operating room nurses burnout, depression, anxiety and compassion fatigue situation in Latvia. Aim and Objectives: Research aim was to find out burnout, depression, compassion fatigue and anxiety presence among surgical care and operating room nurses practicing in Latvia. Methods/Study Design: The research instruments were State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Professional Quality of Life Scale (ProQOL R-V) and Beck Depression Inventory (BDI). Maslach Burnout Inventory helped to assess of three burnout components: emotional exhaustion, depersonalization and rank of personal success for surgical care nurses and operating room nurses. Results/Findings: The participants of the study were 118 surgical care nurses and operating room nurses from several hospitals in Latvia. All participants were women, age range - from 26 till 56 years, with work experience in surgical ward or operating room. The averages for Beck Depression Inventory was 11,96 (±8,93), averages for Professional Quality of Life Scale Compassion Satisfaction subscale was 38,83 (±6,60), for Burnout subscale was 23,40 (±6,75), for Secondary Traumatic Stress subscale was 19,86 (±6,57) averages for State-Trait Anxiety Inventory for state anxiety subscale was 48,39 (±10,61), and for trait subscale was 45,81 (±9,35). Averages for Maslach Burnot Inventory by subscales were for Emotional Exhaustion subscale - 23,49 (±10,82), for Depersonalization subscale was 6,65 (±5,36) and for rank of personal success subscale - 36,73 (±6,97). Study limitations: This study has such limitations as relatively small number of participants and use of some tools not standardized in Latvia. Conclusion: Results of the research indicate burnout presence among surgical care nurses and operating room nurses, as well as indicate levels of anxiety, compassion fatigue and depression. Keywords: Surgical care nurse, operating room nurse, burnout, anxiety, depression, compassion fatigue

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INTRODUCTION / BACKGROUND The healthcare field is becoming more aware of the emotional disturbances that occur in healthcare providers when they witness the suffering and pain of their patients. Stress-related psychological disorders like burn out syndrome, anxiety, depression and compassion fatigue are common among health care professionals. Most often these are people who are highly committed and motivated, who have high standards and idealistic dedication to their jobs. Those conditions more commonly occurs for health care professions, especially nurses.1 A surgical care nurse is a nurse who specializes in perioperative care, meaning care provided to surgical patients before, during, and after surgery. In pre-operative care, a surgical nurse helps to prepare a patient for surgery, both physically and emotionally. Operating room nurses are responsible for maintaining a sterile environment in the operating room and assisting surgeons during operations. Latvia’s social-economic situation is stressful and a lot of nurses still need to work more than in one workplace. There are no complete studies about surgical care nurses and operating room nurses burnout, depression, anxiety and compassion fatigue situation in Latvia. The subject of burnout syndrome is considered to be one of the most critical problems in the 21st century. Maslach and her colleague Jackson first identified the construct "burnout" in the 1970s, and developed a measure that weighs the effects of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment.2 Burnout is a state of emotional and physical exhaustion caused by excessive and prolonged stress.3 The signs of burnout tend to be more mental than physical. They can include feelings of: powerlessness, hopelessness, emotional exhaustion, detachment, isolation, irritability, frustration, being trapped, failure, despair, cynicism, apathy. At the same time some physical symptoms are common: headaches, sleep problems, gastrointestinal problems, chronic fatigue, muscle aches, high blood pressure, frequent colds, sudden weight loss or gain.4 The most widely accepted definition of burnout was formulated by Maslach, who described it as a mental syndrome (along with bodily exhaustion) that develops in people who have a professional relationship with other persons: the worker loses the interest and positive sentiments that he/she had for patients or customers and develops a negative self-image.4 The etiology of burnout is apparently multifactorial.2 Anxiety and depression are common disorders related with stress at work. Anxiety is a normal response to stress or danger. It can help prepare the body for action, and it can improve performance in a range of situations. Anxiety becomes a problem when it is experienced intensely and it persistently interferes with a person's daily life.5 Depressive disorders are a Vol. 2 No 2 (2011)

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huge public-health problem, affecting millions of people. Depression, which is common in healthcare providers compared with the general population in a number of reports, is correlated positively with professional burnout.6 There are several studies about relations among depression, anxiety, burnout related to the stressful work. Compassion fatigue is a quite newly defined disorder, characterized by depressed mood is relationship to work accompanied by feelings of fatigue, disillusionment and worthlessness. Joinson (1992) first coined the term compassion fatigue (CF) while studying burnout in nurses who worked in emergency departments. She suggested that nurses who are empathetic, caring individuals, may absorb the traumatic stress of those they help.7 Nurses may feel chronically tired and irritable, dread going to work or walking into a patient’s room, lack joy in life, feel trapped, drink more alcohol or overeat or experience an aggravation of existing physical ailments, such as headache or body aches. Specific symptoms of CF may include reexperiencing the traumatic event, having intrusive thoughts, avoiding or numbing reminders of the event and having sleep disturbances.8 Stamm (2002) introduced new term linked to compassion fatigue - Professional quality of life. According to Stamm Professional quality of life incorporates two aspects, the positive (Compassion Satisfaction) and the negative (Compassion Fatigue). Compassion fatigue breaks into two parts. The first part concerns things such as such as exhaustion, frustration, anger and depression typical of burnout. Secondary Traumatic Stress is a negative feeling driven by fear and work-related trauma.8

AIM OF THE STUDY Research aim was to find out burnout, depression, compassion fatigue and anxiety presence among surgical care and operating room nurses practicing in Latvia.

METHODS Research performed using quantitative method. The instruments which used for data collection: demographic questionnaire, State-Trait Anxiety Inventory for Adults (by Ch. D. Spielberger), Depression inventory (by A. Beck), Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQOL R-V), Maslach Burnout Inventory (by C. Maslach). To measure burnout we used Maslach's 22- item Burnout Inventory (MBI). It is the most well-studied measurement of burnout in the literature is the Maslach Burnout Inventory. Maslach and Jackson first developed a measure that weighs the effects of emotional Vol. 2 No 2 (2011)

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exhaustion, depersonalization, and reduced sense of personal accomplishment. MBI assesses emotional exhaustion, depersonalization and the lack of personal achievement.9 The Beck Depression Inventory (BDI), created by Dr. Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used instruments for measuring the severity of depression. It is adapted and used in scientific studies in Latvia.10 The State-Trait Anxiety Inventory (STAI) serves as an indicator of two types of anxiety, the state and trait anxiety, and measure the severity of the overall anxiety level. This tool developed by Spielberger, Charles D., translated and adapted in Latvian .11 Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQOL V) developed by B. Hudnall Stamm. Scale consists of 30 questions, 3 subscales: Compassion Satisfaction, Burnout and Secondary Traumatic Stress.12 This scale is translated in Latvian by authors of the article. Descriptive statistics and Pearson's correlation were used for the evaluation of data. Twotailed statistical significance was set at p ≤ 0.01. The computations were carried out with SPSS for Windows, version 17.0, statistical software.

RESULTS The participants of the study were 118 surgical care nurses and operating room nurses from several hospitals in Latvia. All participants were women, age range - from 26 till 56 years. The age range distribution is shown in the Figure 1.

Figure 1: Age range distribution of respondents

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The main descriptive statistic parameters of Beck Depression Inventory are shown in the Table 1. The mean for Beck Depression Inventory total was 11,96 (±8,93), while cognitive subscale it was 6,14 (±5,51) and noncognitive subscale mean was 5,81 (±4,06). Table 1: Descriptive statistic parameters of Beck Depression Inventory (BDI)

Mean Median Mode Std. Deviation Minimum Maximum

BDI (total) 11,96 10,00 8 8,94 0 52

BDI (cognitive subscale) 6,14 5,00 3 5,51 0 36

BDI (noncognitive subscale) 5,81 6,00 6 4,06 0 18

Averages for State-Trait Anxiety Inventory are shown in Table 2. Mean for state anxiety subscale was 48,39 (±10,61), and for trait subscale was 45,81 (±9,35). Table 2: Descriptive statistic parameters of State-Trait Anxiety Inventory (STAI) Mean Median Mode Std. Deviation Minimum Maximum

STAI (state subscale) 48,39 48,00 36 10,61 25 77

STAI (trait subscale) 45,81 45,00 43 9,35 26 73

Descriptive statistical parameters for Maslach Burnot Inventory by subscales are shown in Table 3. Mean for Emotional Exhaustion subscale - 23,49 (±10,82), for Depersonalization subscale was 6,65 (±5,36) and for rank of personal success subscale - 36,73 (±6,97). Table 3: Descriptive statistic parameters of Maslach Burnot Inventory (MBI)


MBI emotional exhaustion subscale 23,49 21,00 37 10,82 4 51

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MBI depersonalization subscale 6,65 5,00 2 5,36 0 24

MBI reduced sense of personal accomplishment 36,73 37,00 41 6,97 18 48

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Averages for Professional Quality of Life Scale are shown in Table 4. Mean for Compassion Satisfaction subscale was 38,83 (±6,60), for Burnout subscale mean was 23,40 (±6,75), for Secondary Traumatic Stress subscale mean was 19,86 (±6,57). Table 4: Descriptive statistic parameters of Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQOL R-V)


ProQOL R-V Compassion Satisfaction subscale

ProQOL R-V Burnout subscale

38,83 39,00 44 6,60 23 50

23,40 23,50 25 6,75 6 44

ProQOL R-V Secondary Traumatic Stress subscale 19,86 19,50 17 6,57 6 39

Some of significant correlations (Pearson correlation coefficient) that we found during data analysis (p ≤ 0.01) between results are correlation between MBI emotional exhaustion subscale and ProQOL R-V Burnout subscale 0,637 (p ≤ 0.01), BDI (total) and ProQOL R-V Burnout subscale 0,534 (p ≤ 0.01), MBI emotional exhaustion subscale and ProQOL R-V Secondary Traumatic Stress subscale 0,540 (p ≤ 0.01). Significant correlations was identified also between STAI (state subscale) and MBI emotional exhaustion subscale 0,512 (p ≤ 0.01), between STAI (state subscale) and ProQOL R-V Burnout subscale 0,538 (p ≤ 0.01), more significant correlation was between STAI (trait subscale) ProQOL R-V Burnout subscale 0,592 (p ≤ 0.01). Significant correlations are also founded between BDI subscales and STAI subscales.

DISCUSSION Results of this study indicate presence of stress related disorders among surgical care nurses and operating room nurses, as well as indicate levels of anxiety, compassion fatigue and depression. The main results of this study shows that 42% of respondents have higher score than mean in BDI total, as well as BDI cognitive subscale, this number is even higher - 51% for BDI noncognitive subscale. Comparing results with a study performed in Greece (Tselebis et al.) where the mean was 8,00 (±6,88) we can conclude that Latvian surgical care nurses and operating room nurses scores are higher, the mean for Beck Depression Inventory total was

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11,96 (±8,93).6

Analyzing STAI results the same way, we discovered that STAI state

subscale 53% and STAI trait subscale 49% results are higher than mean. Results for MBI emotional exhaustion subscale show that 46% of respondents and MBI depersonalization subscale 40% of respondents have higher scores than mean, and MBI reduced sense of personal accomplishment subscale - 42% have lover scores than mean, this subscale lover results indicate higher possibility of burnout, while other two subscales interpretation are traditional - higher scores mean higher possibility to burnout. Comparing results of MBI with a study performed in Greece (Tselebis et al.) where the mean of Emotional Exhaustion subscale was 21,83 (±9,94) and the mean of rank of personal success subscale was 35,36 (±6,54) we can conclude that Latvian surgical care nurses and operating room nurses scores are higher, the mean for Emotional Exhaustion subscale was 23,49 (±10,82) and for rank of personal success subscale - 36,73 (±6,97).6 We founded different situation with the third subscale results - the mean for Depersonalization subscale was 6,65 (±5,36) among Latvian surgical care nurses and operating room nurses which is lower than in a study performed in Greece (Tselebis et al.) where the mean for the third subscale was 8,07 (±6,30).6 The results of ProQOL R-V Compassion Satisfaction subscale shows that 53% have higher scores than mean, ProQOL R-V Burnout subscale - 54% and ProQOL R-V Secondary Traumatic Stress subscale - 50%. Analyzing relations between parameters, the most significant correlations are founded between MBI emotional exhaustion subscale and ProQOL R-V Burnout subscale (r=0,637; p ≤ 0.01). That is not surprising because both instruments are developed to measure burnout. Significant correlations are founded also between BDI subscales and STAI subscales, which means that respondents who have higher scores in BDI also have higher results in STAI. Support services like supervision and counseling should be helpful to prevent health problems of nurses. This requires more research into identifying the most effective way of detecting of early difficulties, and of improving their stress management techniques to help to prevent the transition to severe distress.13 This study has limitations, such number of respondents and adaptation of instruments used for measuring parameters.

CONCLUSIONS This article shows just a part of a research which is started in Riga Stradiņš University and will be performed in the next years. Even now there are results which indicate burnout, Vol. 2 No 2 (2011)

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depression, compassion fatigue and anxiety presence among surgical care nurses and operating room nurses. The research will continue with collecting data among nurses practicing in other fields of health care, which will help to develop prevention program and early recognition of compassion fatigue, burnout and related psychological disorders.

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