Keywords accident emergency burnout emergency c nursing stress
Burnout nursing staff accident emergency acute medicine comparative
study Journal of Clinical Nursing Emergency Nursing study identify
prevalence of burnout nurses working Accident Emergency A & E acute
medicine establish factors contribute stress burnout determine
experiences nurses affected highlight effects patient c determine
stress burnout effects individuals outside clinical setting
triangulated research design used incorporating quantitative
qualitative methods Maslach burnout Inventory used Nurses working
acute medicine experienced levels emotional exhaustion A & E
counterparts level depersonalization low High levels personal
accomplishment experienced Junior members staff Stress burnout
reaching effects nurses clinical practice personal lives nurses work
current environment issues being tackled burnout result science
nursing painful recognition existence stress burnout first steps
prevention Nursing staff working as Accident Emergency A & E acute
medicine spend considerable time during working day intense
interactions people nature A & E department physically demanding
nurses continually faced heavy demands pity sympathy compassion
Malach-Pines 2000 service nurses work cost-conscious ethos
practitioners meeting expectations Maslach et al 1996 persons work
people under circumstances chronic stress emotionally draining
burnout Professional issues clinical nursing Research focus
investigating prevalence burnout medical staff UK Farrington 1999
main reasons why nurses National Health Service NHS prevent increasing
levels stress burnout burnout nursing staff hard evidence extent
Walsh 1998 study various aspects burnout nurses A & E department
acute medical ward NHS Trust term burnout used nursing literature
synonymously stress literature suggest term stress used everyday
language process coping daily rigours life present Thompson 1994
stress demand physical mental energy stress related physiological
problems definition stress harmful pressures excessive Stress first
stage chronic process specific interventions implemented individual
experience burnout Freudenberger 1994 coined term burnout observing
fatigue frustrations caused excessive resources staff working US
Duquette et al 1997 suggested manifestations burnout related work
stress sustained time reported individuals exhibit psychological
psycho-physiologicnl behavioural symptoms burnout described
hnemorrhaging depletion energy personal resources end leaving
individuals help negative Farringtun 1999- burnout manifest
professionals aspects caring Severinnson Kamaker 1999 Hannigan et aL
2000 nurses view burnout occupational hazard Benner Wrubel 1984
indicated experienced burnout nursing series alienated clinical
colleagues nursing series technical tasks caring active sense Client
core people work Bakker et al 1996 clients bring problems caregivers
problems generate tensions caregiver resolve problems insufficient
training shortage personnel lack support colleagues establishment
Vincent Billings 1988 burnout related poor management Boyle 1991
good networks staff helped reduce burnout MeGrath et al 1985 nurses
experienced burnout reduced sense personal accomplishment sense
failure cannot work Hudak Gallo 1994 burnout critical nurses leave
function women experience burnout male counterparts emotionally
involved Almberg et a/ 1997 Pitman Wlow 2000 men minting deeper
levels caring commitment female counterparts females working day
replicate significant experiences childhood dreams expectations
family members Almberg etal 1997 individuals profession high
expectations caring professions personality type open effects
stress burnout Koivulu Paimoncn 2000 notion burnout originate
nursing work characteristics worker environment burnout documented
nursing disciplines detrimental effects demonstrated effects
absence work being tears outbursts individuals high expectations
face hurdles quality nursing conflict symptoms manifest individuals
unable cope Nurse education university-based students encouraged
knowledgeable practical proactive questioning doers Personality types
individual susceptible Dedicated Type individual committed
personality work Over committed Persons tend personality
unsatisfactory life outside work Authoritarian type individual
personality control job strive implement current evidence
practitioners enhance quality patient clinical setting staff
shortages implementation difficult Students climate unable fashion
encouraged resulting patients skills individuals worked Loss control
closely linked burnout Schmitz et al 2000 individuals resolve
inherent difficulties daily work loss control Dolan 1998 lack control
central component experienced burnout nurses control events lives
vulnerable stress burnout nurses personal control social skills
training increase problem solving practical skills Spence 1994
increase autonomy clinical individuals exert control Individuals
working verbal physical aggression prevalent likely experience
effects burnout Coflby 1999- Walsh 1998 A & E fitted requirements
relation prevalence verbal physical aggression Individuals working
ability personal quality crucial therapeutic relationships Nursing
traditionally female dominated profession Howard 1999 inherent
pitfalls female organizations violence Whitehom 1097 A & E argued
violence insidious pervasive environmental stressors police risk
actual violence person American study Whitehgrn 1997 nurses
experienced verbal abuse experienced attempts physical harm victims
physical attacks Effects burnout degree dysfunction exhaustion Tavarcs
1994 Nurses varying symptoms reduced self-esteem lack confidence poor
job satisfaction inability relax enjoy inability things perspective
balanced judgements burnout disease commitment Cherniss 1980
constant desire achieve behavioural terms Maslach 1982 nursing lacking
concern detached impersonal dehumanizing Tavs 1994 innocent victims
negative factors control secret contributors egocentric attitudes
Melchoir et at 1996 lack support central nurses burnout increased
absenteeism reduction productivity Lack support backup Dolan 1998
significant factors staffing problems Edwards et al 2000 social
interpersonal implications symptoms contagious colleagues
Relationships individuals irritable short-tempered coping strategies
combat Millar Burnard 1994 nursing profession stresses leading
personal responsibility nurses attention adjusting working
environment limited attention stress management workplace Koivula
Paunoncn 2000 managers underestimate risks involved require
knowledge development phenomena insight lasting effects return
hospital style matrons local issues nursing colleagues Stordeur et
al 2001 appropriate NHS innovation implemented top down approach
approach increase prevalence burnout nurses managers continue exert
control Stordeur et al 2001 nurses anger managers fear retaliation
redirect anger peers managerial positions recognize suffering
employees difficulty admitting error plans working Schmitz et al
2000 Green 1996 denial problem resulting managers workforce Smoking
Crying Increased alcohol Walsh 1998 amount evidence prevalence
effects contributing factors determining effects individuals
clinical netting qualitative research triangulated research design
quantitative qualitative methods used Polit Hungler 1993 multiple
methods data collection interpretation phenomena accurate
representation Focus group Parahoo 1998 data analysis Non-parametric
tests strength relationships target population age gender clinical
grade comparison clinical settings Maslach burnout inventory Maslach
et al 1996 focuses work individuals statement 22-point questionnaire
tool piloted tested reliability validity consistency widely tested
using Cronbach coefficient alpha Hannigan et aL 2000 tool assess
three aspects burnout syndrome emotional exhaustion depersonalization
personal accomplishment 22-point questionnaire three subscales high
sores emotional exhaustion depersonalization risk burnout low
scores subscales Personal experiences under-represented available
literature open-ended question respondents identify response rate
clinical settings daily work Content analysis work pressures
management medical staff Emotional exhaustion emotionally overextended
exhausted increased prevalence working acute medicine experience
higher levels exhaustion Statistical analysis Mann-Whitney Test
revealed working acute medicine experienced fatigue P = 0039
experienced medium levels emotional exhaustion high levels
exhaustion counterparts Statistical analysis emotional exhaustion
rank P-value relaxed atmosphere Acute high levels exhaustion years
of experience observation emotional exhaustion subscales correlation
between years experience clinical grade relation levels emotional
exhaustion No significance P = univariate analysis of variance
Individual items pertaining subscale yielding responses occurring
Depersonalization subscale measures Analysis highlighted No
statistical significance between burnout Hayter 1999 Personal
accomplishment subscale sampled clinical settings Statistical analysis
Kruskal-Wallis test revealed Focus group interviews relax reflection
roam building Relationship partners siblings total response rate
acute medical ward interpreting findings sample sizes important
indicator highlighting issues study Emotional exhaustion result
nurses working acute medicine experience lower response rate already
experiencing demanding working environment time during working day
Staff shortages figured prominently layout clinical valuable time
resources equipment increasingly used fill gaps roster Skill mix
weekends holidays night shift identified major issues Junior nurses
wards prevalent between grades stress burnout prevalent Chapman
1997 clinically active Cost-effectiveness DHSSPS 2002 stress
burnout coupled increase workload staff perceived patients increasing
expectation what service aggression physical verbal ward setting
staff workload meal breaks clinical setting managerial positions
Vincent & Billings 1988 increasing levels poor leadership management
styles literature indicates managers Green 1996
emotional exhaustion group reflection Taylor 2000 existing practice
potential improvements change team building highlighted factor
contributing stress Wright 2000 morning workplace individuals Content
analysis heavily dependent support medical Senior House Officers
professional boundaries Length shifts reported mentally draining
Shift patterns rotation night duty individuals concentrate
Statistical analysis Nurses acute medicine source stress trolleys
dehumanizing embarrassing Goldberg et al 1996 unremitting stress
demonstrate negativity Walsh 1998 subscale researcher sampled
experienced low levels extreme pressures NHS individualized Hudak &
Gallo 1994 denial of self devalued depersonalized unrecognized Bailey
1988 burnout clinical skills pathway Facilities families
interactions Admission hospital crisis patient family Viney 1996
interactions anxiety increased reassurance better co-operation
improved rapport mutual understanding Quinn 1996 health assistants
provide paperwork Statistical analysis nurses working A & E likely
create relaxed atmosphere acute medicine related higher prevalence
emotional exhaustion nurses working acute medicine analysis revealed
clinical practice create relaxed atmosphere findings accomplishment
decreases support view studies contributing level accomplishment
experienced clinical staff Hayter 1999 interpretation study
highlighted stress clinical individuals personal lives Coping
mechanisms smoking alcohol consumption help nurses busy shift
Ceslowitz 1989 palliative coping mechanisms fundamental problems
untouched Heyworth 1993 argued greater support networks interpersonal
relationships teamwork healthy methods of raising morale lowering
stress Personal relationship problems highlighted attributed long
working hours changes shifts short notice irritable had difficulty
relaxing directing outbursts loved research little attention current
research sample small numbers findings generalized consent forms
Purahoo 1998 multiple comparisons parametric testing non-parametric
statistical procedures used study enhanced validity reliability
likelihood bias gender levels burnout Hayter 1999 link sample
sizes Stress burnout clinical practice outside clinical acute
medicine exhausted counterparts A & ET Individuals holistic
individualized end result perception patients perspective future
research Urgent attention support required tackle identified issues
occupational hazard permanent damage science nursing prevention
Burnout nursing staff accident emergency acute medicine comparative
study Journal of Clinical Nursing Emergency Nursing study identify
prevalence of burnout nurses working Accident Emergency A & E acute
medicine establish factors contribute stress burnout determine
experiences nurses affected highlight effects patient c determine
stress burnout effects individuals outside clinical setting
triangulated research design used incorporating quantitative
qualitative methods Maslach burnout Inventory used Nurses working
acute medicine experienced levels emotional exhaustion A & E
counterparts level depersonalization low High levels personal
accomplishment experienced Junior members staff Stress burnout
reaching effects nurses clinical practice personal lives nurses work
current environment issues being tackled burnout result science
nursing painful recognition existence stress burnout first steps
prevention Nursing staff working as Accident Emergency A & E acute
medicine spend considerable time during working day intense
interactions people nature A & E department physically demanding
nurses continually faced heavy demands pity sympathy compassion
Malach-Pines 2000 service nurses work cost-conscious ethos
practitioners meeting expectations Maslach et al 1996 persons work
people under circumstances chronic stress emotionally draining
burnout Professional issues clinical nursing Research focus
investigating prevalence burnout medical staff UK Farrington 1999
main reasons why nurses National Health Service NHS prevent increasing
levels stress burnout burnout nursing staff hard evidence extent
Walsh 1998 study various aspects burnout nurses A & E department
acute medical ward NHS Trust term burnout used nursing literature
synonymously stress literature suggest term stress used everyday
language process coping daily rigours life present Thompson 1994
stress demand physical mental energy stress related physiological
problems definition stress harmful pressures excessive Stress first
stage chronic process specific interventions implemented individual
experience burnout Freudenberger 1994 coined term burnout observing
fatigue frustrations caused excessive resources staff working US
Duquette et al 1997 suggested manifestations burnout related work
stress sustained time reported individuals exhibit psychological
psycho-physiologicnl behavioural symptoms burnout described
hnemorrhaging depletion energy personal resources end leaving
individuals help negative Farringtun 1999- burnout manifest
professionals aspects caring Severinnson Kamaker 1999 Hannigan et aL
2000 nurses view burnout occupational hazard Benner Wrubel 1984
indicated experienced burnout nursing series alienated clinical
colleagues nursing series technical tasks caring active sense Client
core people work Bakker et al 1996 clients bring problems caregivers
problems generate tensions caregiver resolve problems insufficient
training shortage personnel lack support colleagues establishment
Vincent Billings 1988 burnout related poor management Boyle 1991
good networks staff helped reduce burnout MeGrath et al 1985 nurses
experienced burnout reduced sense personal accomplishment sense
failure cannot work Hudak Gallo 1994 burnout critical nurses leave
function women experience burnout male counterparts emotionally
involved Almberg et a/ 1997 Pitman Wlow 2000 men minting deeper
levels caring commitment female counterparts females working day
replicate significant experiences childhood dreams expectations
family members Almberg etal 1997 individuals profession high
expectations caring professions personality type open effects
stress burnout Koivulu Paimoncn 2000 notion burnout originate
nursing work characteristics worker environment burnout documented
nursing disciplines detrimental effects demonstrated effects
absence work being tears outbursts individuals high expectations
face hurdles quality nursing conflict symptoms manifest individuals
unable cope Nurse education university-based students encouraged
knowledgeable practical proactive questioning doers Personality types
individual susceptible Dedicated Type individual committed
personality work Over committed Persons tend personality
unsatisfactory life outside work Authoritarian type individual
personality control job strive implement current evidence
practitioners enhance quality patient clinical setting staff
shortages implementation difficult Students climate unable fashion
encouraged resulting patients skills individuals worked Loss control
closely linked burnout Schmitz et al 2000 individuals resolve
inherent difficulties daily work loss control Dolan 1998 lack control
central component experienced burnout nurses control events lives
vulnerable stress burnout nurses personal control social skills
training increase problem solving practical skills Spence 1994
increase autonomy clinical individuals exert control Individuals
working verbal physical aggression prevalent likely experience
effects burnout Coflby 1999- Walsh 1998 A & E fitted requirements
relation prevalence verbal physical aggression Individuals working
ability personal quality crucial therapeutic relationships Nursing
traditionally female dominated profession Howard 1999 inherent
pitfalls female organizations violence Whitehom 1097 A & E argued
violence insidious pervasive environmental stressors police risk
actual violence person American study Whitehgrn 1997 nurses
experienced verbal abuse experienced attempts physical harm victims
physical attacks Effects burnout degree dysfunction exhaustion Tavarcs
1994 Nurses varying symptoms reduced self-esteem lack confidence poor
job satisfaction inability relax enjoy inability things perspective
balanced judgements burnout disease commitment Cherniss 1980
constant desire achieve behavioural terms Maslach 1982 nursing lacking
concern detached impersonal dehumanizing Tavs 1994 innocent victims
negative factors control secret contributors egocentric attitudes
Melchoir et at 1996 lack support central nurses burnout increased
absenteeism reduction productivity Lack support backup Dolan 1998
significant factors staffing problems Edwards et al 2000 social
interpersonal implications symptoms contagious colleagues
Relationships individuals irritable short-tempered coping strategies
combat Millar Burnard 1994 nursing profession stresses leading
personal responsibility nurses attention adjusting working
environment limited attention stress management workplace Koivula
Paunoncn 2000 managers underestimate risks involved require
knowledge development phenomena insight lasting effects return
hospital style matrons local issues nursing colleagues Stordeur et
al 2001 appropriate NHS innovation implemented top down approach
approach increase prevalence burnout nurses managers continue exert
control Stordeur et al 2001 nurses anger managers fear retaliation
redirect anger peers managerial positions recognize suffering
employees difficulty admitting error plans working Schmitz et al
2000 Green 1996 denial problem resulting managers workforce Smoking
Crying Increased alcohol Walsh 1998 amount evidence prevalence
effects contributing factors determining effects individuals
clinical netting qualitative research triangulated research design
quantitative qualitative methods used Polit Hungler 1993 multiple
methods data collection interpretation phenomena accurate
representation Focus group Parahoo 1998 data analysis Non-parametric
tests strength relationships target population age gender clinical
grade comparison clinical settings Maslach burnout inventory Maslach
et al 1996 focuses work individuals statement 22-point questionnaire
tool piloted tested reliability validity consistency widely tested
using Cronbach coefficient alpha Hannigan et aL 2000 tool assess
three aspects burnout syndrome emotional exhaustion depersonalization
personal accomplishment 22-point questionnaire three subscales high
sores emotional exhaustion depersonalization risk burnout low
scores subscales Personal experiences under-represented available
literature open-ended question respondents identify response rate
clinical settings daily work Content analysis work pressures
management medical staff Emotional exhaustion emotionally overextended
exhausted increased prevalence working acute medicine experience
higher levels exhaustion Statistical analysis Mann-Whitney Test
revealed working acute medicine experienced fatigue P = 0039
experienced medium levels emotional exhaustion high levels
exhaustion counterparts Statistical analysis emotional exhaustion
rank P-value relaxed atmosphere Acute high levels exhaustion years
of experience observation emotional exhaustion subscales correlation
between years experience clinical grade relation levels emotional
exhaustion No significance P = univariate analysis of variance
Individual items pertaining subscale yielding responses occurring
Depersonalization subscale measures Analysis highlighted No
statistical significance between burnout Hayter 1999 Personal
accomplishment subscale sampled clinical settings Statistical analysis
Kruskal-Wallis test revealed Focus group interviews relax reflection
roam building Relationship partners siblings total response rate
acute medical ward interpreting findings sample sizes important
indicator highlighting issues study Emotional exhaustion result
nurses working acute medicine experience lower response rate already
experiencing demanding working environment time during working day
Staff shortages figured prominently layout clinical valuable time
resources equipment increasingly used fill gaps roster Skill mix
weekends holidays night shift identified major issues Junior nurses
wards prevalent between grades stress burnout prevalent Chapman
1997 clinically active Cost-effectiveness DHSSPS 2002 stress
burnout coupled increase workload staff perceived patients increasing
expectation what service aggression physical verbal ward setting
staff workload meal breaks clinical setting managerial positions
Vincent & Billings 1988 increasing levels poor leadership management
styles literature indicates managers Green 1996
emotional exhaustion group reflection Taylor 2000 existing practice
potential improvements change team building highlighted factor
contributing stress Wright 2000 morning workplace individuals Content
analysis heavily dependent support medical Senior House Officers
professional boundaries Length shifts reported mentally draining
Shift patterns rotation night duty individuals concentrate
Statistical analysis Nurses acute medicine source stress trolleys
dehumanizing embarrassing Goldberg et al 1996 unremitting stress
demonstrate negativity Walsh 1998 subscale researcher sampled
experienced low levels extreme pressures NHS individualized Hudak &
Gallo 1994 denial of self devalued depersonalized unrecognized Bailey
1988 burnout clinical skills pathway Facilities families
interactions Admission hospital crisis patient family Viney 1996
interactions anxiety increased reassurance better co-operation
improved rapport mutual understanding Quinn 1996 health assistants
provide paperwork Statistical analysis nurses working A & E likely
create relaxed atmosphere acute medicine related higher prevalence
emotional exhaustion nurses working acute medicine analysis revealed
clinical practice create relaxed atmosphere findings accomplishment
decreases support view studies contributing level accomplishment
experienced clinical staff Hayter 1999 interpretation study
highlighted stress clinical individuals personal lives Coping
mechanisms smoking alcohol consumption help nurses busy shift
Ceslowitz 1989 palliative coping mechanisms fundamental problems
untouched Heyworth 1993 argued greater support networks interpersonal
relationships teamwork healthy methods of raising morale lowering
stress Personal relationship problems highlighted attributed long
working hours changes shifts short notice irritable had difficulty
relaxing directing outbursts loved research little attention current
research sample small numbers findings generalized consent forms
Purahoo 1998 multiple comparisons parametric testing non-parametric
statistical procedures used study enhanced validity reliability
likelihood bias gender levels burnout Hayter 1999 link sample
sizes Stress burnout clinical practice outside clinical acute
medicine exhausted counterparts A & ET Individuals holistic
individualized end result perception patients perspective future
research Urgent attention support required tackle identified issues
occupational hazard permanent damage science nursing prevention
