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Professional burnout among physicians and nurses in Asian intensive care units: a multinational survey

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Abstract

Purpose

Professional burnout is a multidimensional syndrome comprising emotional exhaustion, depersonalization, and diminished sense of personal accomplishment, and is associated with poor staff health and decreased quality of medical care. We investigated burnout prevalence and its associated risk factors among Asian intensive care unit (ICU) physicians and nurses.

Methods

We conducted a cross-sectional survey of 159 ICUs in 16 Asian countries and regions. The main outcome measure was burnout as assessed by the Maslach Burnout Inventory-Human Services Survey. Multivariate random effects logistic regression analyses of predictors for physician and nurse burnout were performed.

Results

A total of 992 ICU physicians (response rate 76.5%) and 3100 ICU nurses (response rate 63.3%) were studied. Both physicians and nurses had high levels of burnout (50.3% versus 52.0%, P = 0.362). Among countries or regions, burnout rates ranged from 34.6 to 61.5%. Among physicians, religiosity (i.e. having a religious background or belief), years of working in the current department, shift work (versus no shift work) and number of stay-home night calls had a protective effect (negative association) against burnout, while work days per month had a harmful effect (positive association). Among nurses, religiosity and better work-life balance had a protective effect against burnout, while having a bachelor’s degree (compared to having a non-degree qualification) had a harmful effect.

Conclusions

A large proportion of Asian ICU physicians and nurses experience professional burnout. Our study results suggest that individual-level interventions could include religious/spiritual practice, and organizational-level interventions could include employing shift-based coverage, stay-home night calls, and regulating the number of work days per month.

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References

  1. Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422

    Article  CAS  PubMed  Google Scholar 

  2. Dyrbye LN, Massie FS Jr, Eacker A, Harper W, Power D, Durning SJ, Thomas MR, Moutier C, Satele D, Sloan J, Shanafelt TD (2010) Relationship between burnout and professional conduct and attitudes among US medical students. JAMA 304:1173–1180

    Article  CAS  PubMed  Google Scholar 

  3. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN (2016) An official critical care societies collaborative statement-burnout syndrome in critical care health-care professionals: a call for action. Chest 150:17–26

    Article  PubMed  Google Scholar 

  4. Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Pochard F, Chevret S, Schlemmer B, Azoulay E (2007) Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 175:698–704

    Article  PubMed  Google Scholar 

  5. Merlani P, Verdon M, Businger A, Domenighetti G, Pargger H, Ricou B (2011) Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med 184:1140–1146

    Article  PubMed  Google Scholar 

  6. Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, Papazian L (2007) High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med 175:686–692

    Article  PubMed  Google Scholar 

  7. Guntupalli KK, Fromm RE Jr (1996) Burnout in the internist-intensivist. Intensive Care Med 22:625–630

    Article  CAS  PubMed  Google Scholar 

  8. Lu L, Kao SF, Siu OL, Lu CQ (2011) Work stress, Chinese work values, and work well-being in the greater China. J Soc Psychol 151:767–783

    Article  PubMed  Google Scholar 

  9. Iwamoto DK, Liu WM (2010) The impact of racial identity, ethnic identity, asian values and race-related stress on Asian Americans and Asian international college students’ psychological well-being. J Couns Psychol 57:79–91

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jia YA, Rowlinson S, Kvan T, Lingard HC, Yip B (2009) Burnout among Hong Kong Chinese architecture students: the paradoxical effect of confucian conformity values. Constr Manag Econ 27:287–298

    Article  Google Scholar 

  11. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR (2012) Burnout and satisfaction with work–life balance among US physicians relative to the general US population. Arch Intern Med 172:1377–1385

    Article  PubMed  Google Scholar 

  12. Leung DY, Lam TH, Chan SS (2010) Three versions of perceived stress scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health 10:513

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mimura C, Griffiths P (2008) A Japanese version of the perceived stress scale: cross-cultural translation and equivalence assessment. BMC Psychiatry 8:85

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kroenke K, Spitzer RL, Williams JB (2003) The patient health questionnaire-2: validity of a two-item depression screener. Med Care 41:1284–1292

    Article  PubMed  Google Scholar 

  15. Braun V, Clarke V (2014) What can “thematic analysis” offer health and wellbeing researchers? Int J Qual Stud Health Well-being 9:26152

    Article  PubMed  Google Scholar 

  16. Karasek RA (1979) Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q 24:285–308

    Article  Google Scholar 

  17. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Francais A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180:853–860

    Article  PubMed  Google Scholar 

  18. See KC, Lim TK, Kua EH, Phua J, Chua GS, Ho KY (2016) Stress and burnout among physicians: prevalence and risk factors in a Singaporean internal medicine programme. Ann Acad Med Singap 45:471–474

    PubMed  Google Scholar 

  19. Siu C, Yuen SK, Cheung A (2012) Burnout among public doctors in Hong Kong: cross-sectional survey. Hong Kong Med J 18:186–192

    PubMed  Google Scholar 

  20. Wang S, Liu Y, Wang L (2015) Nurse burnout: personal and environmental factors as predictors. Int J Nurs Pract 21:78–86

    Article  CAS  PubMed  Google Scholar 

  21. Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M (2012) The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. Int J Nurs Stud 49:292–299

    Article  PubMed  Google Scholar 

  22. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E (2007) Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care 13:482–488

    Article  PubMed  Google Scholar 

  23. Salyers MP, Bonfils KA, Luther L, Firmin RL, White DA, Adams EL, Rollins AL (2016) The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. J Gen Intern Med 32:475–482

    Article  PubMed  PubMed Central  Google Scholar 

  24. de Oliveira GS Jr, chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, McCarthy RJ (2013) The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesth Analg 117:182–193

    Article  PubMed  Google Scholar 

  25. Danjoux Meth N, Lawless B, Hawryluck L (2009) Conflicts in the ICU: perspectives of administrators and clinicians. Intensive Care Med 35:2068–2077

    Article  PubMed  Google Scholar 

  26. Kanai-Pak M, Aiken LH, Sloane DM, Poghosyan L (2008) Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals. J Clin Nurs 17:3324–3329

    Article  PubMed  Google Scholar 

  27. Stimpfel AW, Sloane DM, Aiken LH (2012) The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Aff 31:2501–2509

    Article  Google Scholar 

  28. Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB (2012) Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad Med 87:845–852

    Article  PubMed  Google Scholar 

  29. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288:1987–1993

    Article  PubMed  Google Scholar 

  30. Giannini A, Miccinesi G, Prandi E, Buzzoni C, Borreani C, Group OS (2013) Partial liberalization of visiting policies and ICU staff: a before-and-after study. Intensive Care Med 39:2180–2187

    Article  PubMed  Google Scholar 

  31. Ali NA, Hammersley J, Hoffmann SP, O’Brien JM Jr, Phillips GS, Rashkin M, Warren E, Garland A (2011) Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing. Am J Respir Crit Care Med 184:803–808

    Article  PubMed  Google Scholar 

  32. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB (2001) The job demands-resources model of burnout. J Appl Psychol 86:499–512

    Article  CAS  PubMed  Google Scholar 

  33. Ho RT, Sing CY, Fong TC, Au-Yeung FS, Law KY, Lee LF, Ng SM (2016) Underlying spirituality and mental health: the role of burnout. J Occup Health 58:66–71

    Article  PubMed  Google Scholar 

  34. Salmoirago-Blotcher E, Fitchett G, Leung K, Volturo G, Boudreaux E, Crawford S, Ockene I, Curlin F (2016) An exploration of the role of religion/spirituality in the promotion of physicians’ wellbeing in emergency medicine. Prev Med Rep 3:189–195

    Article  PubMed  PubMed Central  Google Scholar 

  35. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD (2016) Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 388:2272–2281

    Article  PubMed  Google Scholar 

  36. Ang SY, Dhaliwal SS, Ayre TC, Uthaman T, Fong KY, Tien CE, Zhou H, Della P (2016) Demographics and personality factors associated with burnout among nurses in a Singapore tertiary hospital. Biomed Res Int 2016:6960184

    Article  PubMed  PubMed Central  Google Scholar 

  37. Papazian L, Sylvestre A, Herridge M (2018) Should all ICU clinicians regularly be tested for burnout? Yes. Intensive Care Med 44:681–683

    Article  PubMed  Google Scholar 

  38. Garland A, Roberts D, Graff L (2012) Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses. Am J Respir Crit Care Med 185:738–743

    Article  PubMed  Google Scholar 

  39. Wahlin I, Ek AC, Idvall E (2010) Staff empowerment in intensive care: nurses’ and physicians’ lived experiences. Intensive Crit Care Nurs 26:262–269

    Article  PubMed  Google Scholar 

  40. Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB (2012) Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med 87:853–858

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful for the many ICU physicians and nurses, who generously took time off their busy schedules to complete the survey.

Author information

Authors and Affiliations

  1. Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore

    Kay Choong See & Jason Phua

  2. Department of Critical Care Medicine, Harbin Medical University 1st Hospital, Harbin, China

    Ming Yan Zhao

  3. Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan

    Emiko Nakataki

  4. Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kaweesak Chittawatanarat

  5. Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, and Chang Gung University of Science and Technology, Kaohsiung, Taiwan

    Wen-Feng Fang

  6. Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, Bangladesh

    Mohammad Omar Faruq

  7. Department of Anesthesiology and Reanimation, University of Airlangga, Surabaya, Indonesia

    Bambang Wahjuprajitno

  8. Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Yaseen M. Arabi

  9. Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China

    Wai Tat Wong

  10. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India

    Jigeeshu V. Divatia

  11. Department of Medicine, The Medical City, Pasig, Philippines

    Jose Emmanuel Palo

  12. Department of Anaesthesiology and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal

    Babu Raja Shrestha

  13. Department of Critical Care Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei

    Khalid M. K. Nafees

  14. Department of Intensive Care, Bach Mai Hospital, Hanoi, Vietnam

    Nguyen Gia Binh

  15. Department of Intensive Care, Dubai Hospital, Dubai, United Arab Emirates

    Hussain Nasser Al Rahma

  16. Department of Intensive Care, Mahosot Hospital, Vientiane, Laos

    Khamsay Detleuxay

  17. Medical Affairs-Education, National University Hospital, Singapore, Singapore

    Venetia Ong

  18. The Thai Society of Critical Care Medicine, Bangkok, Thailand

    Kaweesak Chittawatanarat

Authors
  1. Kay Choong See
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  2. Ming Yan Zhao
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  3. Emiko Nakataki
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  5. Wen-Feng Fang
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  6. Mohammad Omar Faruq
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  7. Bambang Wahjuprajitno
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  8. Yaseen M. Arabi
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  9. Wai Tat Wong
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  10. Jigeeshu V. Divatia
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  11. Jose Emmanuel Palo
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  13. Khalid M. K. Nafees
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  14. Nguyen Gia Binh
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  15. Hussain Nasser Al Rahma
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  16. Khamsay Detleuxay
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  17. Venetia Ong
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  18. Jason Phua
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Consortia

SABA Study Investigators and the Asian Critical Care Clinical Trials Group

Corresponding author

Correspondence to Kay Choong See.

Ethics declarations

Human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Ethical approval

Ethical approval was obtained for the overall study in Singapore (NHG-DSRB 2014/01032), and by institutional review boards according to local regulations in each participating centre and country.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

All authors do not have any conflicts of interests to declare. Survey instruments and software were purchased using the authors’ personal funds.

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See, K.C., Zhao, M.Y., Nakataki, E. et al. Professional burnout among physicians and nurses in Asian intensive care units: a multinational survey. Intensive Care Med 44, 2079–2090 (2018). https://doi.org/10.1007/s00134-018-5432-1

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  • DOI: https://doi.org/10.1007/s00134-018-5432-1

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