Influences of the Work Environment on Nurses’ Psychological Wellbeing at Selected Teaching Hospitals in Lusaka, Zambia: A Focus on Secondary Traumatic Stress and Burnout

Michael Mumba Kanyanta; Marjorie Kabinga-Makukula; Ruth Wahila

doi:10.18535/ijsrm/v13i02.mp01

Abstract

Introduction: The current study sought to establish associations of the nurse work environment, with Secondary Traumatic Stress and Burnout among nurses at selected Teaching Hospitals in Lusaka, Zambia.

Methods: A correlational study was conducted at three Teaching Hospitals in Lusaka, Zambia using a stratified sample of 250 nurses. Spearman rank order correlations and hierarchical linear regression were employed to determine correlations among variables at 95% confidence level and 0.05 level of significance.

Results: Secondary Traumatic Stress was positively correlated with levels of nursing workload (r_s = .18, p<.004) and level of stress reported between respondents and their supervisors (r_s = .20, p = .001). Taken together, quality of the respondent’s relationship with the supervisor and the reported level of nursing workload explained 23.7% of the variance in Secondary Traumatic Stress [F (5, 244) = 4.793, p < 0.001, R2 = 0.237]. Reported quality of relationship with the supervisor and reported level of nursing workload also explained 12.1% of the variance in Burnout [F (5, 244) = 6.748, p < 0.001, R2 = 0.121].

Conclusion: Findings of this study suggest a need to develop measures that can enhance good relationships between nurses and their supervisors, reduce nursing workloads and regulate frequency of exposure to severe patient suffering.

Keywords

Secondary Traumatic StressBurnoutPsychological wellbeingNursesWork Environment

References

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Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2013;383(9931):1824–30. doi:10.1016/S0140-6736(13)62631-8.DOI ↗Google Scholar ↗
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Ajeigbe DO, McNeese-Smith D, Leach LS, Phillips LR. Nurse-physician teamwork in the emergency department: impact on perceptions of job environment, autonomy, and control over practice. J Nurs Adm. 2016;46(6):301–8. doi:10.1097/NNA.0000000000000353.DOI ↗Google Scholar ↗
Panunto MR, Guirardello EB. Professional nursing practice: environment and emotional exhaustion among intensive care nurses. Rev Lat Am Enfermagem. 2014;22(6):1041–7. doi:10.1590/0104-1169.3293.2492.DOI ↗Google Scholar ↗
Maurício L, Mantovani MF, Gemito ML, Bernardes A, Guirardello EB, Panunto MR. Predictive factors of adverse events in patients undergoing haemodialysis. J Clin Nurs. 2017;26(23-24):4817–25. doi:10.1111/jocn.13831.DOI ↗Google Scholar ↗
Kanyanta M, Makukula M, Wahila R. Prevalence and Social Demographic Factors Associated with Secondary Traumatic Stress, Burnout and Compassion Satisfaction among Nurses at Selected Teaching Hospitals in Lusaka, Zambia. J Biosci Med. 2023;11:86–104. doi:10.4236/jbm.2023.112007.DOI ↗Google Scholar ↗
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Frey R, Robinson J, Wong C, Gott M. Burnout, Compassion Fatigue and Psychological Capital: Findings from a Survey of Nurses Delivering Palliative Care. Appl Nurs Res. 2018;43:1–9.Google Scholar ↗
Hricova M, Lovašová S. Stress, secondary trauma and burnout-risk characteristics in helping professions. J Interdiscip Res. 2019;8:161–5.Google Scholar ↗
Figley CR. Compassion fatigue as secondary stress disorder: An Overview. In: Figley CR, editor. Compassion fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatised. New York: Brunner – Routledge; 1995. p. 1–20.Google Scholar ↗
Lahana E, Papadopoulou K, Roumeliotou O, Tsounis A, Sarafis P, Niakas D. Burnout among nurses working in social welfare centers for the disabled. BMC Nurs. 2017;16:15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364673/ [Accessed 05/11/2018].Google Scholar ↗
Stamm BH. The Concise ProQOL Manual. 2nd ed. Pocatello, ID: ProQOL.org; 2010. Available from: http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf [Accessed 20/07/2018].Google Scholar ↗
Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):618.Google Scholar ↗
Bellolio MF, Cabrera D, Sadosty AT, et al. Compassion fatigue is similar in emergency medicine residents compared to other medical and surgical specialties. West J Emerg Med. 2014;15(6):629–35.Google Scholar ↗
Berger J, Polivka B, Smoot EA, et al. Compassion fatigue in pediatric nurses. J Pediatr Nurs. 2015;30(6)6–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25800590 [Accessed 10/09/2018].Google Scholar ↗
Mangoulia P, Koukia E, Alevizopoulos G, et al. Prevalence of Secondary Traumatic Stress among Psychiatric Nurses in Greece. Arch Psychiatr Nurs. 2015;29(5):333–8.Google Scholar ↗
Dasan S, Gohil P, Cornelius V, et al. Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants. Emerg Med J. 2016;32:588–94.Google Scholar ↗
Gorgens-Ekermans G, Brand T. Emotional intelligence as a moderator in the stress-burnout relationship: a questionnaire study on nurses. J Clin Nurs. 2012;21(15-16):2275–85.Google Scholar ↗
Van der Doef M, Mbazzi FB, Verhoeven C. Job conditions, job satisfaction, somatic complaints and burnout among east African nurses. J Clin Nurs. 2012;21(11-12):1763–75.Google Scholar ↗
Coetzee SK, Klopper HC, Ellis SM, Aiken LH. A tale of two systems--nurses practice environment, well-being, perceived quality of care and patient safety in private and public hospitals in South Africa: a questionnaire survey. Int J Nurs Stud. 2013;50(2):162–73.Google Scholar ↗
García-Campayo J, Puebla-Guedea M, Herrera-Mercadal P, Daudén E. Burnout syndrome and demotivation among healthcare personnel. Managing Healthcare Employees. 2016;175–97. doi:10.1007/978-3-319-31939-9_10.DOI ↗Google Scholar ↗
Gómez-Urquiza JL, De la Fuente-Solana EI, Albendín-García L, Vargas-Pecino C, Ortega-Campos E, Cañadas-De la Fuente GA. Prevalence of burnout syndrome in emergency nurses: A meta-analysis. Crit Care Nurse. 2017;37(5)6–9. doi:10.4037/ccn2017746.DOI ↗Google Scholar ↗
Roomaney R, Steenkamp J, Kagee A. Predictors of burnout among HIV nurses in the Western cape. Curationis. 2017;40(1)8–9.Google Scholar ↗
Kruse GR, Chapula BT, Ikeda S, et al. Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross-sectional study. Hum Resour Health. 2009;7:55. doi:10.1186/1478-4491-7-55. Available from: http://www.human-resources-health.com/content/7/1/55.DOI ↗Google Scholar ↗
Mutale W, Ayles H, Bond V, Mwanamwenge M, Balabanova D. Measuring health workers’ motivation in rural health facilities: baseline results from three study districts in Zambia. Hum Resour Health. 2013;11(8):1–8.Google Scholar ↗
Ministry of Health (MoH). National Health Strategic Plan, 2022–2026. Lusaka: MoH; 2022.Google Scholar ↗
Dart PJ, Kinnear J, Bould MD, et al. An evaluation of inpatient morbidity and critical care provision in Zambia. Anaesthesia. 2017;72:181–9.Google Scholar ↗
Laschinger HK, Fida R. A time-lagged analysis of the effect of authentic leadership on workplace bullying, burnout, and occupational turnover intentions. Eur J Work Organ Psychol. 2014;23(5):739–53. doi:10.1080/1359432X.2013.804646.DOI ↗Google Scholar ↗
Hunsaker S, Chen HC, Maughan D, et al. Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. J Nurs Scholarsh. 2015;47(2):186–94.Google Scholar ↗
Melnyk BM, Kelly SA, Stephens J, Dhakal K, McGovern C, Tucker S, et al. Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. Am J Health Promot. 2021;35(6):838–60. doi:10.1177/08901171211014884.DOI ↗Google Scholar ↗
Nolte AG, Downing C, Temane A, Hastings-Tolsma M. Compassion fatigue in nurses: A metasynthesis. J Clin Nurs. 2017;26(23-24):4364–78. doi:10.1111/jocn.13766.DOI ↗Google Scholar ↗
Duarte J, Pinto-Gouveia J. The role of psychological factors in oncology nurses' burnout and compassion fatigue symptoms. Eur J Oncol Nurs. 2017;28:114–21. doi:10.1016/j.ejon.2017.04.002.DOI ↗Google Scholar ↗
Kelly L, Lefton C. Effect of meaningful recognition on critical care nurses' compassion fatigue. Am J Crit Care. 2017;26(6):438–44. doi:10.4037/ajcc2017471.DOI ↗Google Scholar ↗
Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021;69(1):96–102. doi:10.1016/j.outlook.2020.06.008.DOI ↗Google Scholar ↗
Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Saf Health Work. 2014;5(3):152–7.Google Scholar ↗
Ziaei M, Yarmohammadi H, Moradi M, Khandan M. Level of Workload and Its Relationship with Job Burnout among Administrative Staff. Int J Occup Hyg. 2015;7(1):53–60. Available from: http://ijoh.tums.ac.ir [Accessed 14/10/2018].Google Scholar ↗
Upton KV. An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: a mixed methods study. J Compassionate Health Care. 2018;5:7. Available from: https://doi.org/10.1186/s40639-018-0050-x [Accessed 10/10/2019].DOI ↗Google Scholar ↗
Jonsson A, Halabi J. Work related post-traumatic stress as described by Jordanian emergency nurses. Accid Emerg Nurs. 2006;14(2):89–96. doi:10.1016/j.aaen.2006.03.006.DOI ↗Google Scholar ↗
Kroenke, K, Spitzer, R.L, Williams, J.B., Löwe, B. The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010; 32:345-59.Google Scholar ↗

[refR-1] Mabona F, van Rooyen RM, Jordan J, ten Ham-Baloyi W. Work environment in the South African military health service experienced by nurses: A qualitative study. Int J Afr Nurs Sci. 2019;11:100171. doi:10.1016/j.ijans.2019.100171.DOI ↗Google Scholar ↗

[refR-2] Wei H, Sewell KA, Woody G, Rose MA. The state of the science of nurse work environments in the United States: A systematic review. Int J Nurs Sci. 2018;5:287–300. doi:10.1016/j.ijnss.2018.04.010.DOI ↗Google Scholar ↗

[refR-3] Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2013;383(9931):1824–30. doi:10.1016/S0140-6736(13)62631-8.DOI ↗Google Scholar ↗

[refR-4] Twigg DE, McCullough K. Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. Int J Nurs Stud. 2014;51(1):85–92. doi:10.1016/j.ijnurstu.2013.05.015.DOI ↗Google Scholar ↗

[refR-5] Ajeigbe DO, McNeese-Smith D, Leach LS, Phillips LR. Nurse-physician teamwork in the emergency department: impact on perceptions of job environment, autonomy, and control over practice. J Nurs Adm. 2016;46(6):301–8. doi:10.1097/NNA.0000000000000353.DOI ↗Google Scholar ↗

[refR-6] Panunto MR, Guirardello EB. Professional nursing practice: environment and emotional exhaustion among intensive care nurses. Rev Lat Am Enfermagem. 2014;22(6):1041–7. doi:10.1590/0104-1169.3293.2492.DOI ↗Google Scholar ↗

[refR-7] Maurício L, Mantovani MF, Gemito ML, Bernardes A, Guirardello EB, Panunto MR. Predictive factors of adverse events in patients undergoing haemodialysis. J Clin Nurs. 2017;26(23-24):4817–25. doi:10.1111/jocn.13831.DOI ↗Google Scholar ↗

[refR-8] Kanyanta M, Makukula M, Wahila R. Prevalence and Social Demographic Factors Associated with Secondary Traumatic Stress, Burnout and Compassion Satisfaction among Nurses at Selected Teaching Hospitals in Lusaka, Zambia. J Biosci Med. 2023;11:86–104. doi:10.4236/jbm.2023.112007.DOI ↗Google Scholar ↗

[refR-9] Sacco TL, Ciurzynski SM, Harvey ME, Ingersoll GL. Compassion Satisfaction and Compassion Fatigue among Critical Care Nurses. Crit Care Nurse. 2015;35(4):32–43.Google Scholar ↗

[refR-10] Frey R, Robinson J, Wong C, Gott M. Burnout, Compassion Fatigue and Psychological Capital: Findings from a Survey of Nurses Delivering Palliative Care. Appl Nurs Res. 2018;43:1–9.Google Scholar ↗

[refR-11] Hricova M, Lovašová S. Stress, secondary trauma and burnout-risk characteristics in helping professions. J Interdiscip Res. 2019;8:161–5.Google Scholar ↗

[refR-12] Figley CR. Compassion fatigue as secondary stress disorder: An Overview. In: Figley CR, editor. Compassion fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatised. New York: Brunner – Routledge; 1995. p. 1–20.Google Scholar ↗

[refR-13] Lahana E, Papadopoulou K, Roumeliotou O, Tsounis A, Sarafis P, Niakas D. Burnout among nurses working in social welfare centers for the disabled. BMC Nurs. 2017;16:15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364673/ [Accessed 05/11/2018].Google Scholar ↗

[refR-14] Stamm BH. The Concise ProQOL Manual. 2nd ed. Pocatello, ID: ProQOL.org; 2010. Available from: http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf [Accessed 20/07/2018].Google Scholar ↗

[refR-15] Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):618.Google Scholar ↗

[refR-16] Bellolio MF, Cabrera D, Sadosty AT, et al. Compassion fatigue is similar in emergency medicine residents compared to other medical and surgical specialties. West J Emerg Med. 2014;15(6):629–35.Google Scholar ↗

[refR-17] Berger J, Polivka B, Smoot EA, et al. Compassion fatigue in pediatric nurses. J Pediatr Nurs. 2015;30(6)6–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25800590 [Accessed 10/09/2018].Google Scholar ↗

[refR-18] Mangoulia P, Koukia E, Alevizopoulos G, et al. Prevalence of Secondary Traumatic Stress among Psychiatric Nurses in Greece. Arch Psychiatr Nurs. 2015;29(5):333–8.Google Scholar ↗

[refR-19] Dasan S, Gohil P, Cornelius V, et al. Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants. Emerg Med J. 2016;32:588–94.Google Scholar ↗

[refR-20] Gorgens-Ekermans G, Brand T. Emotional intelligence as a moderator in the stress-burnout relationship: a questionnaire study on nurses. J Clin Nurs. 2012;21(15-16):2275–85.Google Scholar ↗

[refR-21] Van der Doef M, Mbazzi FB, Verhoeven C. Job conditions, job satisfaction, somatic complaints and burnout among east African nurses. J Clin Nurs. 2012;21(11-12):1763–75.Google Scholar ↗

[refR-22] Coetzee SK, Klopper HC, Ellis SM, Aiken LH. A tale of two systems--nurses practice environment, well-being, perceived quality of care and patient safety in private and public hospitals in South Africa: a questionnaire survey. Int J Nurs Stud. 2013;50(2):162–73.Google Scholar ↗

[refR-23] García-Campayo J, Puebla-Guedea M, Herrera-Mercadal P, Daudén E. Burnout syndrome and demotivation among healthcare personnel. Managing Healthcare Employees. 2016;175–97. doi:10.1007/978-3-319-31939-9_10.DOI ↗Google Scholar ↗

[refR-24] Gómez-Urquiza JL, De la Fuente-Solana EI, Albendín-García L, Vargas-Pecino C, Ortega-Campos E, Cañadas-De la Fuente GA. Prevalence of burnout syndrome in emergency nurses: A meta-analysis. Crit Care Nurse. 2017;37(5)6–9. doi:10.4037/ccn2017746.DOI ↗Google Scholar ↗

[refR-25] Roomaney R, Steenkamp J, Kagee A. Predictors of burnout among HIV nurses in the Western cape. Curationis. 2017;40(1)8–9.Google Scholar ↗

[refR-26] Kruse GR, Chapula BT, Ikeda S, et al. Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross-sectional study. Hum Resour Health. 2009;7:55. doi:10.1186/1478-4491-7-55. Available from: http://www.human-resources-health.com/content/7/1/55.DOI ↗Google Scholar ↗

[refR-27] Mutale W, Ayles H, Bond V, Mwanamwenge M, Balabanova D. Measuring health workers’ motivation in rural health facilities: baseline results from three study districts in Zambia. Hum Resour Health. 2013;11(8):1–8.Google Scholar ↗

[refR-28] Ministry of Health (MoH). National Health Strategic Plan, 2022–2026. Lusaka: MoH; 2022.Google Scholar ↗

[refR-29] Dart PJ, Kinnear J, Bould MD, et al. An evaluation of inpatient morbidity and critical care provision in Zambia. Anaesthesia. 2017;72:181–9.Google Scholar ↗

[refR-30] Laschinger HK, Fida R. A time-lagged analysis of the effect of authentic leadership on workplace bullying, burnout, and occupational turnover intentions. Eur J Work Organ Psychol. 2014;23(5):739–53. doi:10.1080/1359432X.2013.804646.DOI ↗Google Scholar ↗

[refR-31] Hunsaker S, Chen HC, Maughan D, et al. Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. J Nurs Scholarsh. 2015;47(2):186–94.Google Scholar ↗

[refR-32] Melnyk BM, Kelly SA, Stephens J, Dhakal K, McGovern C, Tucker S, et al. Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. Am J Health Promot. 2021;35(6):838–60. doi:10.1177/08901171211014884.DOI ↗Google Scholar ↗

[refR-33] Nolte AG, Downing C, Temane A, Hastings-Tolsma M. Compassion fatigue in nurses: A metasynthesis. J Clin Nurs. 2017;26(23-24):4364–78. doi:10.1111/jocn.13766.DOI ↗Google Scholar ↗

[refR-34] Duarte J, Pinto-Gouveia J. The role of psychological factors in oncology nurses' burnout and compassion fatigue symptoms. Eur J Oncol Nurs. 2017;28:114–21. doi:10.1016/j.ejon.2017.04.002.DOI ↗Google Scholar ↗

[refR-35] Kelly L, Lefton C. Effect of meaningful recognition on critical care nurses' compassion fatigue. Am J Crit Care. 2017;26(6):438–44. doi:10.4037/ajcc2017471.DOI ↗Google Scholar ↗

[refR-36] Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. 2021;69(1):96–102. doi:10.1016/j.outlook.2020.06.008.DOI ↗Google Scholar ↗

[refR-37] Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Saf Health Work. 2014;5(3):152–7.Google Scholar ↗

[refR-38] Ziaei M, Yarmohammadi H, Moradi M, Khandan M. Level of Workload and Its Relationship with Job Burnout among Administrative Staff. Int J Occup Hyg. 2015;7(1):53–60. Available from: http://ijoh.tums.ac.ir [Accessed 14/10/2018].Google Scholar ↗

[refR-39] Upton KV. An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: a mixed methods study. J Compassionate Health Care. 2018;5:7. Available from: https://doi.org/10.1186/s40639-018-0050-x [Accessed 10/10/2019].DOI ↗Google Scholar ↗

[refR-40] Jonsson A, Halabi J. Work related post-traumatic stress as described by Jordanian emergency nurses. Accid Emerg Nurs. 2006;14(2):89–96. doi:10.1016/j.aaen.2006.03.006.DOI ↗Google Scholar ↗

[refR-41] Kroenke, K, Spitzer, R.L, Williams, J.B., Löwe, B. The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010; 32:345-59.Google Scholar ↗