Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors
Abstract
:1. Introduction
- How prevalent are BOS symptoms among ICU nurses during the COVID-19 pandemic?
- Which individual, organizational, and contextual factors are associated with the risk of, and protection against, BOS among ICU nurses during the COVID-19 pandemic?
2. Methods
2.1. Study Design
2.2. Keywords and Search Query
2.3. Bibliographical Databases
2.4. Inclusion and Exclusion Criteria
2.5. Methodological Quality Assessment
2.6. Data Extraction
2.7. Ethical Considerations
3. Results
3.1. Methodological Quality Assessment of the Selected Studies
3.2. Overview of the Selected Studies
3.3. Prevalence of BOS among ICU Nurses during the COVID-19 Pandemic
3.4. Individual, Organizational, and Contextual Factors Related to BOS among ICU Nurses during the COVID-19 Pandemic
3.4.1. Results from Quantitative Studies
3.4.2. Results from Qualitative and Mixed-Method Studies
Reference | Study Period | Participants | Measures | Main Results |
---|---|---|---|---|
Bergman et al., 2021 [36] | May 2020 | 151 ICU nurses (131 moved to the ICU due to pandemic) | Thirteen multiple-choice questions, including questions about participants’ specialist training, years of clinicalexperience, workplace, number of patients per shift, and introductionand training regarding COVID-19 patients. | The situation of not being able to provide nursing care resulted in ethical stress and led to an increased workload and worsened work environment, which affected nurses’ health and well-being. |
Bruyneel et al., 2021 [37] | April–May 2020 | 1135 ICU nurses | Maslach Burnout Inventory (MBI) | Overall, 68% of ICU nurses were at risk of BOS. A total of 29% were at risk for depersonalization (DP), 31% for reduced personal accomplishment (PA), and 38% for emotional exhaustion (EE). A nurse–patient ratio of 1:3 increased the risk of EE and DP. High workload was associated with a higher risk for BOS. A lack of protective equipment increased the risk of EE. The presence of COVID-19-like symptoms without being tested increased the risk of EE. |
Cadge et al., 2021 [45] | June–August 2020 | 16 ICU nurses (8 already in ICU, 8 moved to ICU due to pandemic) | Semi-structured interviews with questions about working under unfamiliar circumstances, caring for patients with a new infectious disease, risks to themselves and their family, ideas on additional support they would find helpful. | Participants emphasized the importance of nurse leadership support during this experience. Leadership practices that maximize visibility and support facilitated individual and group well-being and minimized BOS risk. |
Çelik and Kiliç, 2022 [46] | May–June 2020 | 18 ICU nurses | Individual in-depth interview: two questions were asked by the authors, namely: (1) Can you explain the effects of the COVID-19 pandemic on your relations with your family? (2) How does the COVID-19 pandemic affect you? | The study investigated three themes: breakdown in continuity of intrafamilial relationship, ineffectiveness in role performance, and ineffective individual coping. Nurses suffered from family relationship breakdown and insufficiency in intrafamilial coping; they reported to live a tiring life with great responsibility and face mental problems such as burnout syndrome and depression. |
Christianson et al., 2022 [47] | November 2020–January 2021 | 13 ICU Nurses | One-on-one semi-structured interviews conducted by nurses following broad questions about the lived experience of nurses about the pandemic, e.g., can you tell me about what it has been like towork in the ICU during the COVID-19 pandemic? | Nurses reported betrayal at perceived breeches in their duty-of-care agreement by their employers, the society, and national health authorities. Alterations to previous standards of care such as significantly increased workloads, worsening understaffing, and changes to patient-care expectations that were implemented for reasons other than the betterment of patient care. Nurses reported to feel a moral obligation to provide care while experiencing disempowerment and burnout that affected them both in and out of the workplace. |
Crowe et al., 2022 [38] | May–June 2021 | 425 ICU Nurses | Quantitative measures: the Impact of Event Scale—Revised (IES–R), the Depression, Anxiety, Stress Scale (DASS–21), the Professional Quality of Life scale (ProQoL), and the Intent to Turnover scale; Qualitative questions: optional open-ended question asking participants if there was anything else they wanted to share. | Nurses had symptoms of post-traumatic stress disorder (74%), depression (70%), anxiety (57%), and stress (61%). All (100%) nurses showed moderate-to-high burnout, 87% suffering from signs of secondary traumatic stress, and 22% intended to quit their current employment. Qualitative analysis of written comments submitted by 147 (34.5%) of the respondents depicted an immense mental health toll on the ICU that stemmed from (1) failed leadership and (2) the traumatic nature of the work environment, which led to (3) a sense of disillusionment, defeat, and an intent to leave. |
Guttormson et al., 2022 [39] | October 2020–January 2021 | 285 ICU nurses | Closed questions on respondents’ characteristics, work setting, and challenges during the pandemic. Three open questions: (1) What do you want people to know about your experience during the COVID-19 pandemic? (2) Please, describe the greatest challenges you faced caring for COVID-19 patients. (3) Please, describe any positive things you observed or experienced during COVID-19. | Nurses reported stress due to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. They perceived inadequate leadership support and inequity within working teams. They felt isolated due to a lack of consistent community efforts to slow the virus spread. Nurses reported exhaustion, anxiety, sleeplessness, moral distress, and fear of contracting COVID-19 or infecting family and friends. |
Kagan et al., 2022 [40] | February–May 2021 | 115 ICU nurses (15 for the focus group and 100 for the cross-sectional study) | Quantitative measures: professional functioning, emotional stress at work, State Hope Scale, Nurses’ uncertainty, and Shirom–Melamed Burnout Measure; Qualitative measure: 15 focus groups. | Qualitative data analysis revealed challenges of the COVID-19 pandemic and positive aspects of the COVID-19 pandemic. Nurses reported high levels of burnout, emotional stress, and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. |
Kurt Alkan et al., 2022 [41] | February–April 2021 | 116 ICU nurses | Descriptive Information Form, COVID-19 Fear Scale, Depression, Anxiety and Stress Scale Short Form and Burnout Short Version, COVID-19 Fear Scale. | Strong associations among the presence of moderate-to-high symptoms of depression, anxiety, stress, and burnout levels among ICU nurses. |
Ndlovu et al., 2022 [42] | January–May 2020 | 154 ICU nurses | Professional Quality of Life comprising dimensions of compassion satisfaction, burnout, and secondary traumatic stress disorder. | The high workload, which may have been associated with the COVID-19 pandemic, influenced nurses’ professional quality of life. |
Omidi et al., 2022 [43] | July 2020–January 2021 | 140 ICU nurses | Maslach Burnout Inventory (MBI) and the WHO Quality of Life-BREF. | Positive associations between personal accomplishment and all dimensions of QoL and a negative association between emotional exhaustion, depersonalization of burnout and QOL dimensions. |
Vitale et al., 2020 [44] | March–April 2020 | 291 ICU nurses (132 moved to ICU due to pandemic) | Maslach Burnout Inventory (MBI). | A total of 90.4% of the nurses reported above-threshold values for EE, 8.2% for DP, and 24.4% for reduced PA. Female nurses reported higher negative values than men for the only EE dimension. |
4. Discussion
4.1. Limitations and Recommendations for Future Research
4.2. Practical Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
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Appendix B
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Bergman et al., 2021 [36] | Bruyneel et al., 2021 [37] | Crowe et al., 2022 [38] | Guttormson et al., 2022 [39] | Kagan et al., 2022 [40] | Kurt Alkan et al., 2022 [41] | Ndlovu et al., 2022 [42] | Omidi et al., 2022 [43] | Vitale et al., 2020 [44] | |
---|---|---|---|---|---|---|---|---|---|
Q1 | YES | YES | UNCLEAR | YES | YES | YES | UNCLEAR | YES | YES |
Q2 | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Q3 | YES | YES | YES | UNCLEAR | YES | YES | YES | YES | UNCLEAR |
Q4 | YES | YES | YES | UNCLEAR | YES | YES | UNCLEAR | YES | UNCLEAR |
Q5 | YES | YES | YES | UNCLEAR | YES | YES | NO | YES | YES |
Q6 | YES | YES | YES | UNCLEAR | YES | YES | NO | YES | YES |
Q7 | YES | YES | YES | UNCLEAR | YES | YES | YES | YES | YES |
Q8 | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Cadge et al., 2021 [45] | Çelik and Kiliç, 2022 [46] | Christianson et al., 2022 [47] | Crowe et al., 2022 [38] | Guttormson et al., 2022 [39] | Kagan et al., 2022 [40] | |
---|---|---|---|---|---|---|
Q1 | UNCLEAR | YES | YES | YES | YES | YES |
Q2 | YES | YES | YES | YES | YES | YES |
Q3 | YES | YES | YES | YES | YES | YES |
Q4 | YES | YES | YES | YES | YES | YES |
Q5 | YES | YES | YES | YES | YES | YES |
Q6 | YES | YES | YES | YES | YES | YES |
Q7 | YES | YES | YES | YES | UNCLEAR | YES |
Q8 | YES | YES | YES | YES | YES | YES |
Q9 | YES | YES | YES | YES | YES | YES |
Q10 | YES | YES | YES | YES | YES | YES |
Reference | Scientific Journal | Publisher | Country | Study Period | Participants | Method | Main Goals |
---|---|---|---|---|---|---|---|
Bergman et al., 2021 [36] | Nursing in Critical Care | Wiley | Sweden | May 2020 | 151 ICU nurses (131 moved to ICU due to pandemic) | Quantitative | Describe ICU nurses’ experiences of caring for patients with COVID-19 in ICUs during the pandemic. |
Bruyneel et al., 2021 [37] | Intensive and Critical Care Nursing | Elsevier | Belgium | April–May 2020 | 1135 ICU nurses | Quantitative | Assess the BOS risk prevalence and identify risk factors among ICU nurses during the COVID-19 pandemic. |
Cadge et al., 2021 [45] | Journal of Nursing Management | Wiley | United States | June– August 2020 | 16 ICU nurses (8 already in ICU, 8 moved to ICU due to pandemic) | Qualitative | Understand how nurses experienced care of COVID-19-positive patients within ICUs. |
Çelik and Kiliç, 2022 [46] | World Journal of Clinical Cases | Baishideng Publishing Group | Turkey | May–June 2020 | 18 ICU nurses | Qualitative | Explore nurses’ anxiousness about themselves, their children and family, and inability to cope with the situation during the pandemic. |
Christianson et al., 2022 [47] | SAGE Open Nursing | Sage | United States | November 2020–January 2021 | 13 ICU Nurses | Qualitative | Examine the impact of the COVID-19 pandemic on the duty-of-care balanceamong ICU nurses who manage COVID-19 patients. |
Crowe et al., 2022 [38] | Intensiveand Critical Care Nursing | Springer | Canada | May–June 2021 | 425 ICU Nurses | Mixed methods | Examine the impact of the COVID-19 pandemic on ICU nurses’ mental health, quality of work life, and intent to stay in their current positions. |
Guttormson et al., 2022 [39] | American Journal of Critical Care | American Association of Critical-Care Nurses | United States | October 2020–January 2021 | 285 ICU nurses | Mixed methods | Describe the experiences of US ICU nurses in the COVID-19 pandemic. |
Kagan et al., 2022 [40] | Journal of Nursing Scholarship | Wiley | Israel | February–May 2021 | 115 ICU nurses (15 for the focus group and 100 for the cross-sectional study) | Mixed methods | Examine the challenges of operating and managing intensive care units during the COVID-19 pandemic among ICU nurse managers, and the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic. |
Kurt Alkan et al., 2022 [41] | OMEGA—Journal of Death and Dying | Sage | Turkey | February–April 2021 | 116 ICU nurses | Quantitative | Examine the relation between the fear of COVID-19 and depression, anxiety, and burnout of ICU nurses during the pandemic. |
Ndlovu et al., 2022 [42] | Southern African Journal of Critical Care | Critical Care Society of Southern Africa | South Africa | January–May 2020 | 154 ICU nurses | Quantitative | Describe the demographic factors associated with professional quality of life of critical care nurses working in Gauteng, South Africa. |
Omidi et al., 2022 [43] | Journal of Neonatal Nursing | Springer | Iran | July 2020–January 2021 | 140 ICU nurses | Quantitative | Determine the association between burnout and nurses’ quality of life in ICU nurses during the pandemic. |
Vitale et al., 2020 [44] | Minerva Psichiatrica | Minerva Medica | Italy | March–April 2020 | 291 ICU nurses (132 moved to ICU due to pandemic) | Quantitative | Assess the BOS level among ICUs nurses caring for COVID-19-positive Patients. |
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Toscano, F.; Tommasi, F.; Giusino, D. Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors. Int. J. Environ. Res. Public Health 2022, 19, 12914. https://doi.org/10.3390/ijerph191912914
Toscano F, Tommasi F, Giusino D. Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors. International Journal of Environmental Research and Public Health. 2022; 19(19):12914. https://doi.org/10.3390/ijerph191912914
Chicago/Turabian StyleToscano, Ferdinando, Francesco Tommasi, and Davide Giusino. 2022. "Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors" International Journal of Environmental Research and Public Health 19, no. 19: 12914. https://doi.org/10.3390/ijerph191912914