It has dysfunctional repercussions on the individual and adverse effects on the organisation. It may reflect in a continued dissatisfaction with the situation, ranging from mild boredom to severe depression, irritation, exhaustion, and physical ailment. The experience of too much pressure and very few sources of satisfaction can develop into a feeling of exhaustion leading to burnout.

Burnout is a psychological term for the negative response to chronic job-related emotional stress. In other words, burnout results from people giving too much of their time, energy and effort on the job over a long period of time without adequate time to recover physically or emotionally. The prevalence of burnout among physicians ranges from 25% to 60% and occurs at a level sufficient to affect personal or professional performance. Among nurses/midwives,                      15%-85% have reported burnout. The prevalence varies by medical specialty and working conditions. When comparing nurses to physicians or other healthcare workers, nurses consistently reported higher levels of burnout.^[2]

NEED FOR THE STUDY

Unfortunately, most of the studies on burnout in nursing have been conducted in Europe and United States. There are few studies from Asian countries. In view of the paucity of Indian studies in this area, the present work was undertaken to identify the predictors of burnout in an Indian healthcare population. As the socio-cultural background of Indian healthcare workers varies widely from their Western counterparts, we expected to identify predictors of burnout relevant to them. Finding predictors of burnout relevant in an Indian setting should have important policy implications in Human Resource Management in this sector in similar developing countries.^[3]

A health workforce crisis is crippling health service delivery in many low-income countries. High-income countries with high salaries and attractive living conditions are drawing qualified doctors and nurses from poorer countries to fill gaps in their own human resources pool. This migration of skilled labour is depleting human capital in many developing countries.^[4] The human resource crisis in India is acute.

Although burnout in large organisations has been examined in many studies, in general there has been a lack of concentration on healthcare workers and on hospital settings, especially in India. In addition, there are relatively few studies investigating burnout among Indian healthcare workers. To the best of investigators’ knowledge, there is a paucity of such work in this field in the state of Assam, which is another major reason to undertake this study.

Moreover with the increasing complexities and the changing patterns of society, the stress in the environment leading to burnout is increasing day by day. Study of burnout and factors influencing it will therefore enable us to find out suitable ways to reduce stress among healthcare workers and thereby improving the quality of health care. Thus, the need for the study is felt.

Therefore, this study is designed to identify degree and factors that influence burnout among emergency healthcare workers in hospital.

STATEMENT OF THE PROBLEM

Degree of burnout among emergency healthcare workers and factors influencing level of burnout.

OBJECTIVES OF THE STUDY

1. To examine the degree of burnout reported by healthcare workers of Emergency Department.
2. To find out the relationship between burnout and demographic variables like age, sex, religion, marital status, years married, general and professional education, children and number of children.
3. To explore factors that may influence the level of burnout among healthcare workers working in Emergency Department.

HYPOTHESES

H1: There is significant association between burnout and socio-demographic variables.

H2: There is significant association between selected factors and burnout.

METHODOLOGY

SETTING OF THE STUDY

Gauhati Medical College Hospital (GMCH), Guwahati, Assam was selected as the setting of the study.

POPULATION

Doctors, nurses, and other healthcare workers who are working in the Emergency Department of GMCH.

SAMPLE

For the purpose of present study, 62 numbers of health care workers will be selected.

When sampling for a qualitative characteristic is done (i.e., to estimate the proportion of individuals with a certain characteristic in a population), one need to state:

• A rough approximation to the proportion (p). This ‘p’ value is taken from past experiences.
• The sampling error that can be tolerated (d). Usually, the assumption made is that ‘d’ does not exceed 10% to 20% of ‘p’.
• The level of confidence or the accepted chance of an unlucky sample (conventionally 95% confidence limit or 5% chance).
• The required sample size is:

Sample size, n =   ;

                where q=1 - p

Baishya et al.^[5] in their study among nurses of the Maternity Department in GMCH, found in emotional exhaustion, the low-level, moderate, and high-level burnouts were 80, 18, and 2 respectively. In “depersonalisation,” the low-level, moderate, and high-level burnouts were 39, 38 and 23, respectively. In personal achievement the low-level, moderate, and high-level burnouts were 84, 11 and 5, respectively.

From past experience, p = 61%; thus

p=0.61

q=1–0.61 = 0.39

d=20% of ‘p’=0.122

Sample size, n=(4×0.61×0.39)/(0.122)²=61.40»62.

SAMPLING TECHNIQUE

Random sampling method will be adopted for selecting the samples in the present study.

Inclusion Criteria

1. Health care workers who will be available during the data collection period (from September 2014 to August 2015).

2. Health care workers who are willing to participate in the study.

DESCRIPTION OF TOOLS

Demographic Proforma: It is prepared to gather the background information regarding the participations under study. It consists of eight items. Variables are socio-demographic data, e.g. age, sex, religion, marital status, years married, education, children and number of children.

FACTORS INFLUENCING LEVEL OF BURNOUT: It consists of 12 items. These are travelling time to work, working hours per week, doctor/doctor conflict or nurse/nurse conflict, nurse/doctor conflict, availability of doctors/nurses to work with, lack or inadequate nursing personnel, poor wages, too frequent night duties, inadequate security during night duties, job status, years in current job and additional work.

It was evident from the literature review that because of the very nature of the type of data required to be analysed to assess level of burnout and factors that may influence the level of burnout among health care workers, standardised tools are essential. After an extensive literature search, authors found that Maslach Burnout Inventory (MBI) is the golden scale for assessing burnout among healthcare workers.

Burnout self-test (MBI) is subdivided into three categories:

• Section A – Emotional exhaustion.
• Section B – Depersonalisation.
• Section C – Personal achievement.

MBI contains 22 items which are answered as never, a few times per year, once a month, a few times per month, once a week, a few times per week and every day.

Section A – Emotional exhaustion contains seven items.

Section B – Depersonalisation contains seven items.

Section C – Personal achievement contains eight items.

SCORING

Section A: Emotional Exhaustion

Emotional Exhaustion: Testifies to fatigue at the very idea of work, chronic fatigue, trouble sleeping, physical problems. For the MBI as well as for most authors, “exhaustion would be the key component of the syndrome.” Unlike depression, the problems disappear outside work.

• Total 17 or less: Low-level burnout.
• Total between 18 and 29 inclusive: Moderate burnout.
• Total over 30: High-level burnout.

Section B: Depersonalisation

“Depersonalisation” (or loss of empathy): Rather a “dehumanisation” in interpersonal relations. The notion of detachment is excessive, leading to cynicism with negative attitudes with regard to patients or colleagues, feeling of guilt, avoidance of social contacts and withdrawing into oneself. The professional blocks the empathy he can show to his patients and/or colleagues.

• Total 5 or less: Low-level burnout.
• Total between 6 and 11 inclusive: Moderate burnout.
• Total of 12 and greater: High-level burnout.

Section C: Personal Achievement

The reduction of personal achievement: The individual assesses himself negatively, feels he is unable to move the situation forward. This component represents the demotivating effects of a difficult, repetitive situation leading to failure despite efforts. The person begins to doubt his genuine abilities to accomplish things. This aspect is a consequence of the first two.

• Total 33 or less: High-level burnout.
• Total between 34 and 39 inclusive: Moderate burnout.
• Total greater than 40: Low-level burnout.

A high score in the first two sections and a low score in the last section may indicate burnout.

TRANSLATION OF THE SCALE

The inventory was translated from English into local language Assamese by an expert not related to this study. It was later back-translated into English by another independent expert, not acquainted with the original version. The back-translation was subsequently compared with the original version by a psychiatrist for conceptual equivalence of the items. Necessary finer adjustments were made to convey the correct information to the participants.

RELIABILITY OF THE SCALE

The reliability of the scale was established by data collected from ten staff nurses, who are working in the Maternity Department of Gauhati Medical College Hospital. The reliability has been drawn by using Split-Half Spearman Brown Formula. The formula is as follows:

r_SB=2r/(1+r)

where r is the Pearson Product moment correlation co-efficient.

Reliability of Emotional Exhaustion

The calculated value of r=0.79

Hence, r_SB=0.88

Since the calculated value of r_SB (Reliability) is 0.88, which is highly reliable, the tool can be used for main study.

Reliability of Depersonalisation

The calculated value of r=0.65

Hence, r_SB=0.79

Since the calculated value of r_SB (Reliability) is 0.79, which is highly reliable, the tool can be used for main study.

Reliability of Personal Achievement

The calculated value of r=0.76

Hence, r_SB=0.86

Since the calculated value of r_SB (Reliability) is 0.86, which is highly reliable, the tool can be used for main study.

ETHICAL CLEARANCE

The study has been approved by the institutional ethical committee. Formal written administrative permission will be applied. Informed consent will be obtained from participants.

DATA COLLECTION PROCEDURE

The period of data collection was from September 2014 to August 2015.

Data collected for the present study will be through structured questionnaires. The data on demography, factors influencing the level of burnout, and the degree of burnout will be collected using this method. Participants will be informed of the purpose of the study and those interested will be given questionnaires that included the measure employed in this study.

The test will be administered among doctors, nurses and other health care workers working in Emergency Department of GMCH. The investigator will give self-introduction and explain the purpose of the study to obtain free and frank responses. The participants will be assured confidentiality of their responses.

It will take a minimum of 10 to 15 minutes for the participants to respond to the questionnaire and investigator will be personally present each time the test will be administered.