Coping Strategies to Reduce Burnout Syndrome in Nursing Staff Volume 54- Issue 1

Rodrigo Poot Balam², Mildreth Lisseth Canul Baeza², María Rebeca Sosa Cárdenas¹*, Lucy Minelva Oxté Oxté¹ and Saul May Uitz¹*

• ¹Profesores de Carrera, Universidad Autónoma de Yucatán, México
• ²Estudiante de Enfermería en Administración y Docencia en Enfermería, México

Received: December 01, 2023; Published: December 12, 2023

*Corresponding author: Saul May Uitz, Profesores de Carrera, Universidad Autónoma de Yucatán, México

DOI: 10.26717/BJSTR.2023.54.008499

Abstract PDF

Objective: To identify coping strategies as an intervention to reduce the levels of burnout syndrome in nursing professionals.

Methodology: Quantitative research, bibliographic review type, question in the PIO framework, from which terms were identified and translated into documentary language through DeCS and MeSH, the sources consulted for the search were: PubMed, CUIDEN, COCHRANE, BVS, Dialnet, DOAJ, EBSCO, Science Direct, Epistemonikos, university nursing journal UNAM, evidence-based nursing, evidentia, SciELO, IMSS nursing journal, Redalyc, web of Science, Spanish Medical Index (IME), Medigraphic, fisterra, google scholar, jurn, Trip Database, considering articles no older than 7 years of publication that evaluate the use of coping strategies to reduce burnout levels in nursing professionals, with no language limit, excluding articles that do not involve nursing professionals. Boolean operators (AND, OR) were used as an effective search strategy, and the selection of articles was in accordance with the title and abstract.

Results: 307,946 were found, of which, according to the criteria, 307,931 were eliminated, 15 were selected to evaluate their quality using the FLC 3.0 critical reading sheets. The synthesis and interpretation were carried out by assigning a level of evidence and degree of recommendation with the Sackett scale.

Conclusions: The evidence showed that coping strategies are useful to reduce burnout levels, highlighting group strategies, such as psychoeducation, social support, behavior modification, cognitive-behavioral therapy, as well as the importance of considering them in institutional curricula and work programs.

Keywords: Health Personnel; Nursing; Professional Burnout; Psychological Adaptation; Strategies; Behavior; Syndrome; Social Support; Job Satisfaction

Abbreviations: SB: Bournout Syndrome; EE: Emotional Exhaustion; DP: Depersonalization; PA: Lack of Personal Fulfillment; VHL: Virtual Health Library; FLC: Critical Reading Worksheets; WHO: World Health Organization; DOAJ: Directory of Open Access Journal; UNAM: National Autonomous University of Mexico; IMSS: Mexican Institute of Social Security; IME: Spanish Medical Index

Burnout syndrome (BS) or also called occupational burnout "is a condition in response to prolonged pressures, emotional and interpersonal stressors related to work", that health personnel suffer; these workers, especially nursing staff, have to face circumstances such as new diseases or pandemics and added to this the workload, these situations result in intense acute and/or chronic stress, anxiety, depressive symptoms, insomnia, denial, anger, fear, as well as increased conflicts (Central Library of the Ministry of Health, 2021). In 1981, Maslach and Jackson highlighted three main characteristics for SB: "emotional exhaustion (EE), depersonalization (PD), and lack of personal fulfillment (PA)." EE refers to emptiness and exhaustion in the face of the demands of a task, which can lead to indifference and lack of interest in the needs of the other person. The second, depersonalization (PD), which considers a rejection of patients, originating a series of inhuman, negative, cold attitudes, where the individual refuses to be polite. The third is lack of personal fulfillment (BP), according to Tuesca et al. It consists of "a negative attitude towards oneself and towards work, loss of interest in it, irritability, low productivity and poor self-esteem"; the individual feels a professional failure and the collapse of their self-esteem can lead to depression (Vargas, et al. [1,2]). Burnout syndrome is considered a public health problem, which affects both collectively and individually; For example, if the person has this condition chronically, it can generate an increase in the consumption of addictive substances such as coffee, alcohol, tobacco, barbiturates, food, among others and have harmful effects physically, psychologically and emotionally; in turn, it increases economic and social costs. This syndrome was recognized as a disease by the World Health Organization (WHO) (WHO [3]; Miranda, et al. [4-11]). Personnel with these emotional conditions deteriorate the work environment and generate conflicts with co-workers and family members, as well as having a high impact on the performance of work activities (Aguilar, et al. [12-16]). Therefore, the aim of the study was: To identify coping strategies as an intervention to reduce the levels of burnout syndrome in nursing professionals.

Quantitative research type of literature review: the search was carried out in the period from September 5, 2021, to March 10, 2022. The sources consulted were the following databases: PubMed, CUIDEN, Cochrane, VHL, Dialnet, DOAJ, EBSCO, Science Direct, Epistemonikos; Journals: UNAM University Nursing Journal, Evidence Based Nursing, Evidentia, SciELO, IMSS Nursing Journal, Redalyc, Web of Science, Spanish Medical Index (IME), Medigraphic; Meta search engines, fisterra, google Scholar, JURN, Trip Database. These consultations were based on the terms generated in the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH), in order to have a controlled language and effective search; free terms were also used (See Table 1). The aforementioned search was limited to publications that were 7 years old, conducted in Spanish, English and Portuguese.

Table 1: Controlled Language Terms [30,31].

Note: Source: Authors’ own creation *DeCS, ** MeSH, ***libres

Among the inclusion criteria, articles with a systematic review design, meta-analysis, clinical trials and observational cohort studies, studies carried out in nursing professionals over 18 years of age, which have been evaluated through a test to identify the levels of Burnout and the effectiveness of coping strategies in the face of Burnout, were considered. Articles older than 10 years of publication were discarded, those that compared only other mental illnesses and presented methodological biases. Boolean operators AND and OR were used to create algorithms for a precise search [(health personnel) AND (burnout) AND (coping strategies), Burnout AND nursing OR nurses AND coping strategies OR coping, ((((Burnout) OR (Stress)) AND (Nursing)) AND (Nurses)) AND (Coping)) AND (Care)] (*) was also used as truncation. The initial selection of the articles was through the reading of the title and abstract. Critical reading was carried out to evaluate the quality of the evidence using the web platform: Critical Reading Sheets 3.0 (FLC 3.0) (López, et al. [17]); The "SACKETT" scale was used to rank the evidence to assign the level of evidence and the degree of recommendation. Based on Table 1 and the Boolean operators, the syntax of the search strings (according to the search sources) was as follows:

PubMed: (((((Burnout) OR (Stress)) AND (Nursing)) AND (Nurses)) AND (Coping)) AND (Care)

1. BVS: (Health Personnel) AND (burnout) AND (Coping Strategies)

2. Dial net: Burnout syndrome and coping strategies in health personnel.

3. EBSCO: Burnout AND nursing OR nurses AND coping strategies OR coping.

Journals, Metasearch Engines, and Other Databases

1. Burnout AND nursing OR nurses OR Doctors AND coping strategies OR coping

2. Burnout AND nursing AND coping

3. Burnout OR stress AND nursing OR nurses AND Doctors AND coping.

For the selection and exclusion of articles, the title and abstract were considered. Similarly, critical reading was carried out to evaluate the quality of the evidence using the web platform: Critical Reading Sheets 3.0 (FLC 3.0) (López, et al. [17); selecting the evaluation format, according to the design of each of the articles, the "SACKETT" scale was used to grade the level of evidence.

A total of 307,946 articles were found during the effective search, of which, based on the inclusion and exclusion/elimination criteria established, 15 articles eligible for critical reading were selected, and among the other 307,931 articles, 302,047 articles were mainly eliminated because they did not show evidence of the application of coping strategies as an intervention to reduce burnout syndrome. 3191 that did not use any scale to determine the levels of burnout in nursing professionals, and 2693 that did not involve nursing professionals. Critical reading was carried out to assess the quality of the evidence using the web platform "Critical Reading Sheets 3.0" (FLC 3.0) (López, et al. [17); selecting the evaluation format, according to the design of each of the articles, through the scale of the platform, obtaining that the 15 (100%) articles met the necessary characteristics to be considered relevant in relation to the objective of the research, of which, 3 (20%) are systematic reviews with meta-analysis, 4 (26.6%) clinical trials, 1 (6.6%) case-control study, 6 (40%) systematic reviews. (See Table 2).

Table 2: Synthesis and gradation of evidence.

The evidence found showed that the application of the various existing coping strategies can benefit the mental health of nursing department staff (Jan, et al. [18]), however, in several studies, the importance of interventions being appropriate according to the type of work environment and the personality of nursing professionals was emphasized. Linked to this, it was found that psychoeducation plays a very important role for professionals to have the knowledge, value and reflect on the importance of preserving their mental health (Vargas, et al. [1]), otherwise, the tests applied may not be answered sincerely, which can represent a significant risk of bias, which would limit the analysis of strategies that can contribute to their mental well-being. The evidence is clear, there is a high rate of burnout syndrome in nursing professionals, either due to the context of the health system, work overload or the emotions that the profession requires to cope with during the working day, so it is of great importance that nursing managers are concerned about considering mental health as a priority for the organization. Likewise, it was found that the learning and coping of professionals must be carried out in a comprehensive way, contemplating other areas such as self-care, nutrition, rest, among others (Meléndez, et al. [8]). Thus, in order to select the appropriate coping strategy, it is necessary to know the context and the personnel with whom you work. The congruence of the positive effects generated by the use of coping strategies in nursing professionals is highlighted, as mentioned by the author Arrogante (2016) [19] about the interventions that have demonstrated significant effectiveness, such as workshops or specific training programs on adaptive strategies to work stress; as well as programs that include relaxation techniques, addressing maladaptive or erroneous cognitions, the implementation of information sessions or meetings, the promotion of social relationships and social support, the latter also coincided with Osorio, et al. [2] and with the results of the present study. On the other hand, the latter author also found that the most used strategies were related to rational coping with situations, for example, problem solving, positive reappraisal and the search for social support, which also coincided in this study [20-30].

Based on the analysis of the 15 retrieved articles referring to the effects of the use of coping strategies to reduce burnout syndrome in health personnel, including nursing professionals, 100% of them show favorable results that indicate a decrease in this syndrome, in its 3 dimensions, that is, depersonalization, emotional exhaustion, and self-fulfillment. With the above, it is evident the need to apply or plan methodologically strategies such as psychoeducation in the curricula and training programs for nursing personnel, who, as has been documented, demonstrated a high rate of this mental condition, with a critical decrease in productivity and work performance in institutions of any level of care. It is important to conclude that all coping strategies have their usefulness; However, it is important to note that they must be implemented according to the characteristics, needs and conditions of the institution to guarantee results. Among the most relevant strategies are psychoeducation, social or organizational support, behavior modification, group cognitive-behavioral therapy, positive orientation, among other strategies that use technology such as the strategy called "3 good things", where a group social network was used and in which the staff shares 3 good things that happened to them during their workday daily.

Likewise, systematic reviews show the need to plan interventions not only with a therapeutic emphasis, but also with a preventive one, with a multicomponent approach, that is, combining the most useful, integrating aspects such as the resilient coping capacity of the staff, the ability to adapt, emotional intelligence, leadership, relaxation activities such as yoga or meditation, Likewise, if relevant, encompass the spiritual realm. In the same way, it proved useful to employ strategies focused on self-care and self-confidence, in such a way that other factors that impact the coping capacity of the staff are addressed, such as an adequate diet, adequate sleep time, to achieve this balance, it is required a good coordination and strategic planning of the administrative staff responsible for planning the roles and activities of the staff. so that there is a relevant organization related to working hours, teamwork and shift work. Finally, some authors also concluded on the importance of generating more primary studies to obtain more quality scientific evidence, where the relationship between coping strategies and the level of job satisfaction is compared. In this study, strategies for BS such as psycho-education and social support by co-workers and supervisors were found, which reported positive results.

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