Evolution and Treatment of Academic Burnout in Nursing Students: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Search Strategy
2.2. Study Selection
3. Results
3.1. Study Selection Process and Studies Characteristics
3.2. Evolution of Burnout and Related Factors during Nursing Studies
3.3. Interventions to Alleviate Burnout in Nursing Students
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Maslach, C.; Jackson, S. MBI: Maslach Burnout Inventory; Manual Research Edition; Consulting Psychologists Press: Palo Alto, CA, USA, 1986. [Google Scholar]
- Choi, B.S.; Kim, J.S.; Lee, D.W.; Paik, J.W.; Lee, B.C.; Lee, J.W.; Lee, H.S.; Lee, H.Y. Factors associated with emotional exhaustion in south Korean nurses: A cross-sectional study. Psychiatry Investig. 2018, 15, 670. [Google Scholar] [CrossRef]
- Membrive-Jiménez, M.J.; Gómez-Urquiza, J.L.; Suleiman-Martos, N.; Monsalve-Reyes, C.; Romero-Béjar, J.L.; Cañadas-De la Fuente, G.A.; De la Fuente-Solana, E.I. Explanatory Models of Burnout Diagnosis Based on Personality Factors and Depression in Managing Nurses. J. Pers. Med. 2022, 12, 438. [Google Scholar] [CrossRef]
- Ramírez-Elvira, S.; Romero-Béjar, J.L.; Suleiman-Martos, N.; Gómez-Urquiza, J.L.; Monsalve-Reyes, C.; Cañadas-De la Fuente, G.A.; Albendín-García, L. Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 11432. [Google Scholar] [CrossRef]
- Domínguez, C.C.; Martínez, C.H.; Sañudo, J.E.P. El burnout académico: Delimitación del síndrome y factores asociados con su aparición. Rev. Latinoam. Psicol. 2010, 42, 131–146. [Google Scholar]
- Aguayo, R.; Cañadas, G.R.; Assbaa-Kaddouri, L.; Cañadas-De la Fuente, G.A.; Ramírez-Baena, L.; Ortega-Campos, E. A Risk Profile of Sociodemographic Factors in the Onset of Academic Burnout Syndrome in a Sample of University Students. Int. J. Environ. Res. Public Health 2019, 16, 707. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cho, S.; Lee, M.; Lee, S. Burned-Out Classroom Climate, Intrinsic Motivation, and Academic Engagement: Exploring Unresolved Issues in the Job Demand-Resource Model. Psychol. Rep. 2022. [Google Scholar] [CrossRef]
- Wang, M.; Guan, H.; Li, Y.; Xing, C.; Rui, B. Academic burnout and professional self-concept of nursing students: A cross-sectional study. Nurse Educ. Today 2019, 77, 27–31. [Google Scholar] [CrossRef]
- Ghods, A.A.; Ebadi, A.; Sharif Nia, H.; Allen, K.A.; Ali-Abadi, T. Academic burnout in nursing students: An explanatory sequential design. Nurs. Open 2023, 10, 535–543. [Google Scholar] [CrossRef]
- Barboza, J.I.R.A.; Beresin, R. A síndrome de burnout em graduandos de enfermagem. Einstein 2007, 5, 225–230. [Google Scholar]
- Breso, E.; Salanova, M. Factores Psicosociales y Salud en Muestras Preprofesionales; Universidad de la Rioja: Logroño, Spain, 2009. [Google Scholar]
- Martínez, I.M.M.; Esteve, E.B.; Gumbau, S.L.; Gumbau, R.G. Bienestar psicológico en estudiantes universitarios: Facilitadores y obstaculizadores del desempeño académico. Anal. Psychol. 2005, 21, 170–180. [Google Scholar]
- Igbokwe, U.L.; Nwokenna, E.N.; Eseadi, C.; Ogbonna, C.S.; Nnadi, E.M.; Ololo, K.O.; Enyoghasim, O.M.; Otu, O.A.; Uma, K.E.; Onuora, T.N.; et al. Intervention for burnout among English education undergraduates: Implications for curriculum innovation. Medicine 2019, 98, e16219. [Google Scholar] [CrossRef] [PubMed]
- De Vries, J.D.; van Hooff, M.L.M.; Geurts, S.A.E.; Kompier, M.A.J. Exercise as an Intervention to Reduce Study-Related Fatigue among University Students: A Two-Arm Parallel Randomized Controlled Trial. PLoS ONE 2016, 11, e0152137. [Google Scholar] [CrossRef] [PubMed]
- Buffel du Vaure, C.; Lemogne, C.; Bunge, L.; Catu-Pinault, A.; Hoertel, N.; Ghasarossian, C.; Vincens, M.E.; Galam, E.; Jaury, P. Promoting empathy among medical students: A two-site randomized controlled study. J. Psychosom. Res. 2017, 103, 102–107. [Google Scholar] [CrossRef] [PubMed]
- Nolan, T.; Lim, N.; Khan, M. Medical student’s thoughts on interventions to reduce burnout and maintain empathy in clinical years. Med. Teach. 2019, 41, 1448–1449. [Google Scholar] [CrossRef]
- Wündrich, M.; Schwartz, C.; Feige, B.; Lemper, D.; Nissen, C.; Voderholzer, U. Empathy training in medical students—A randomized controlled trial. Med. Teach. 2017, 39, 1096–1098. [Google Scholar] [CrossRef]
- Daya, Z.; Hearn, J.H. Mindfulness interventions in medical education: A systematic review of their impact on medical student stress, depression, fatigue and burnout. Med. Teach. 2018, 40, 146–153. [Google Scholar] [CrossRef]
- Van der Riet, P.; Levett-Jones, T.; Aquino-Russell, C. The effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review. Nurse Educ. Today 2018, 65, 201–211. [Google Scholar] [CrossRef]
- Hathaisaard, C.; Wannarit, K.; Pattanaseri, K. Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis. Asian J. Psychiatry 2022, 69, 102997. [Google Scholar] [CrossRef]
- Kong, L.N.; Yang, L.; Pan, Y.N.; Chen, S.Z. Proactive personality, professional self-efficacy and academic burnout in undergraduate nursing students in China. J. Prof. Nurs. 2021, 37, 690–695. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
- OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Available online: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence (accessed on 18 December 2022).
- Bittman, B.B.; Snyder, C.; Bruhn, K.T.; Liebfreid, F.; Stevens, C.K.; Westengard, J.; Umbach, P.O. Recreational music-making: An integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: Insights and economic impact. Int. J. Nurs. Educ. Scholarsh. 2004, 1, 12. [Google Scholar] [CrossRef] [PubMed]
- Pelit-Aksu, S.; Özkan-Şat, S.; Yaman-Sözbir, Ş.; Şentürk-Erenel, A. Effect of progressive muscle relaxation exercise on clinical stress and burnout in student nurse interns. Perspect. Psychiatr. Care 2021, 57, 1095–1102. [Google Scholar] [CrossRef]
- Frögéli, E.; Djordjevic, A.; Rudman, A.; Livheim, F.; Gustavsson, P. A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses. Anxiety Stress Coping 2016, 29, 202–218. [Google Scholar] [CrossRef] [PubMed]
- Ayaz-Alkaya, S.; Yaman-Sözbir, Ş.; Bayrak-Kahraman, B. The effect of nursing internship program on burnout and professional commitment. Nurse Educ. Today 2018, 68, 19–22. [Google Scholar] [CrossRef] [PubMed]
- Bulfone, G.; Fida, R.; Ghezzi, V.; Macale, L.; Sili, A.; Alvaro, R.; Palese, A. Nursing Student Self-efficacy in Psychomotor Skills: Findings from a Validation, Longitudinal, and Correlational Study. Nurse Educ. 2016, 41, E1–E6. [Google Scholar] [CrossRef]
- Burisch, M. A longitudinal study of burnout: The relative importance of dispositions and experiences. Work Stress 2002, 16, 1–17. [Google Scholar] [CrossRef]
- Deary, I.J.; Watson, R.; Hogston, R. A longitudinal cohort study of burnout and attrition in nursing students. J. Adv. Nurs. 2003, 43, 71–81. [Google Scholar] [CrossRef]
- Fornés-Vives, J.; García-Banda, G.; Frias-Navarro, D.; Pascual-Soler, M. Longitudinal study predicting burnout in Spanish nurses: The role of neuroticism and emotional coping. Pers. Individ. Differ. 2019, 138, 286–291. [Google Scholar] [CrossRef]
- Haack, M.R. Stress and impairment among nursing students. Res. Nurs. Health 1988, 11, 125–134. [Google Scholar] [CrossRef]
- Rudman, A.; Gustavsson, J.P. Burnout during nursing education predicts lower occupational preparedness and future clinical performance: A longitudinal study. Int. J. Nurs. Stud. 2012, 49, 988–1001. [Google Scholar] [CrossRef] [PubMed]
- Watson, R.; Deary, I.; Thompson, D.; Li, G. A study of stress and burnout in nursing students in Hong Kong: A questionnaire survey. Int. J. Nurs. Stud. 2008, 45, 1534–1542. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dyrbye, L.; Shanafelt, T. A narrative review on burnout experienced by medical students and residents. Med. Educ. 2016, 50, 132–149. [Google Scholar] [CrossRef]
- Hansell, M.W.; Ungerleider, R.M.; Brooks, C.A.; Knudson, M.P.; Kirk, J.K.; Ungerleider, J.D. Temporal Trends in Medical Student Burnout. Fam. Med. 2019, 51, 399–404. [Google Scholar] [CrossRef] [Green Version]
- Caminati, G.; Cappelli, L.; Ferri, P.; Artioli, G.; Spadola, M.; Vecchiatini, M.; Melotto, M.; Di Lorenzo, R.; Rubbi, I. Emotional impact of clinical practice in Burns Unit among nursing students: A qualitative study. Acta BioMed. 2021, 92 (Suppl. S2), e2021008. [Google Scholar] [CrossRef] [PubMed]
- Weurlander, M.; Lönn, A.; Seeberger, A.; Broberger, E.; Hult, H.; Wernerson, A. How do medical and nursing students experience emotional challenges during clinical placements? Int. J. Med. Educ. 2018, 9, 74–82. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- De la Fuente-Solana, E.I.; Gómez-Urquiza, J.L.; Cañadas, G.R.; Albendín-García, L.; Ortega-Campos, E.; Cañadas-De la Fuente, G.A. Burnout and its relationship with personality factors in oncology nurses. Eur. J. Oncol. Nurs. 2017, 30, 91–96. [Google Scholar] [CrossRef]
- Ortega-Campos, E.; Cañadas-De la Fuente, G.A.; Albendín-García, L.; Gómez-Urquiza, J.L.; Monsalve-Reyes, C.; de la Fuente-Solana, E.I. A Multicentre Study of Psychological Variables and the Prevalence of Burnout among Primary Health Care Nurses. Int. J. Environ. Res. Public Health 2019, 16, 3242. [Google Scholar] [CrossRef] [Green Version]
- Lahey, B.B. Public health significance of neuroticism. Am. Psychol. 2009, 64, 241–256. [Google Scholar] [CrossRef] [Green Version]
- Tambağ, H. Examination of nursing students’ anxiety levels related to clinical practice with respect to peer support. Perspect. Psychiatr. Care 2021, 57, 1114–1119. [Google Scholar] [CrossRef]
- Sun, F.K.; Long, A.; Chiang, C.Y.; Wu, M.K.; Yao, Y. The psychological processes voiced by nursing students when caring for suicidal patients during their psychiatric clinical practicum: A qualitative study. J. Clin. Nurs. 2020, 29, 525–534. [Google Scholar] [CrossRef]
- Roca, J.; Canet-Vélez, O.; Cemeli, T.; Lavedán, A.; Masot, O.; Botigué, T. Experiences, emotional responses, and coping skills of nursing students as auxiliary health workers during the peak COVID-19 pandemic: A qualitative study. Int. J. Ment. Health Nurs. 2021, 30, 1080–1092. [Google Scholar] [CrossRef]
- Vargas, C.; Cañadas, G.A.; Aguayo, R.; Fernández, R.; de la Fuente, E.I. Which occupational risk factors are associated with burnout in nursing? A meta-analytic study. Int. J. Clin. Health Psychol. 2014, 14, 28–38. [Google Scholar] [CrossRef]
- Cañadas-De la Fuente, G.A.; Ortega, E.; Ramirez-Baena, L.; De la Fuente-Solana, E.I.; Vargas, C.; Gomez-Urquiza, J.L. Gender, marital status and children as risk factors for burnout in nurses: A meta-analytic study. Int. J. Environ. Res. Public Health 2018, 15, 2102. [Google Scholar] [CrossRef] [Green Version]
- Bagheri, T.; Fatemi, M.J.; Payandan, H.; Skandari, A.; Momeni, M. The effects of stress-coping strategies and group cognitive-behavioral therapy on nurse burnout. Ann. Burn. Fire Disasters 2019, 32, 184–189. [Google Scholar]
- Finnerty, R.; Zhang, K.; Tabuchi, R.A.; Zhang, K. The Use of Music to Manage Burnout in Nurses: A Systematic Review. Am. J. Health Promot. 2022, 36, 1386–1398. [Google Scholar] [CrossRef] [PubMed]
- Suleiman-Martos, N.; Gomez-Urquiza, J.L.; Aguayo-Estremera, R.; Cañadas-De La Fuente, G.A.; De La Fuente-Solana, E.I.; Albendín-García, L. The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. J. Adv. Nurs. 2020, 76, 1124–1140. [Google Scholar] [CrossRef] [PubMed]
Authors, Year of Publication, and Country | Type of Study | Sample | Intervention or Follow up Time | Results | EL and GR |
---|---|---|---|---|---|
Ayaz-Alkaya et al., 2018. Turkey [27] | Quasi-experimental study | n = 101. 87.1% of the sample was female. | Nursing internship programme (two courses with 3 h of theory and 18 practical training per week for one academic year). Training was about internal medicine, general surgery, gynaecology, paediatric, psychiatry, and public health clinics. Students were responsible for caring (under supervision) for patients. | Burnout prevalence was significantly increased after the internship, from 34.7% to 43.6%. Additionally, students with dangerous signs of burnout or requiring help were increased. | B/2b |
Bittman et al., 2004. United States [24] | Crossover clinical trial | n = 75. 85.3% of the sample was female. The mean age was 27.5. | Six-week intervention with one session per week about recreational music. The HealthRHYTHMS Group Empowerment Drumming Protocol® was followed with instruments such as hand drums, SoundShapes®, and percussion auxiliary instruments. Control group continued its academic routines. | EE (25.9 to 23.2 points) and D (6.4 to 5.1 points) showed a significant reduction after the intervention. | A/1b |
Bulfone et al., 2016. Italy [28] | Quantitative longitudinal study (cohort study) | n = 571. 70.6% of the sample was female. The mean age was 22.7. | First measure was at the beginning of the second year, and second measure was at the beginning of the third year. | The correlation of burnout with low-complexity self-efficacy psychomotor skills increased from −0.12 to -0.22, such as middle complexity self-efficacy from −0.07 to −0.21. High complexity self-efficacy did not significantly change. | B/2b |
Burisch, 2002. Germany [29] | Quantitative longitudinal study (cohort study) | n = 221. 74% of the sample was female. The mean age was 21.4. | First measure during their first week prior to practical training and then after each half-year (seven points of measures). | Dispositional variables (life satisfaction, health concerns, lack of hobbies, addiction, emotional isolation and others, etc.), particularly the “attitudinal” components, helped to predict burnout scores of the three dimensions. R = 0.70 for EE, R = 0.69 for D, and R = 0.60 for PA. The experiences (inventory of nursing stresses, job environment, and conditions, tedium), particularly the “emotional” components during nursing studies, helped to predict the evolution and score of emotional exhaustion at the end of the study. R = 0.70 for EE, R = 0.69 for 0.38 for D, and R = 0.50 for PA. The differences in the burnout scores among the seven measures did not show any pattern. | B/2b |
Deary et al., 2003. United Kingdom [30] | Quantitative longitudinal study (cohort study) | n = 168 students. 89% of the sample was female. The mean age was 25.4. | First data collection was performed upon entry into nurse education, second collection at 12 months, third collection at 24 months, and fourth collection at the end of the nursing programme. | The burnout scores were stable during the nursing programme. Only the personal accomplishment scores significantly increased during the study. Some personality traits were correlated with EE and D but not all the measures. PA was correlated with conscientiousness over the duration of the study. Emotion-oriented coping was correlated with EE at the second measure only and task-oriented coping with PA only at time 2. | B/2b |
Fornés-Vives et al., 2019. Spain [31] | Quantitative longitudinal study (cohort study) | n = 249. 88.5% of the sample was female. The mean age was 20.97. | At the beginning of nursing studies and at the end. | EE and D were significantly correlated with neuroticism at both measures. EE was significantly correlated with emotional coping and behavioural coping at both measures. PA was only correlated with emotional coping at the firs measure. | B/2b |
Frogeli et al., 2015. Sweden [26] | Randomised controlled pilot trial | n = 69 intervention group. n = 44 control group. No data about gender or mean age | The intervention consisted of six group sessions of 2-h using behaviour therapy to target stress. It included information about behaviour change strategies, lifestyle factors, communication and assertiveness skills, and training in acceptance and commitment therapy. The control condition consisted of two seminars of 3 h for reflection about personal and professional development. | The intervention group had significantly lower levels of burnout than the control group at post-intervention (2.1 vs 2.8). Cohen’s d = 0.82. The difference was not significant at three months of follow-up. | A/1b |
Haack, 1988. United States [32] | Quantitative longitudinal study (cohort study) | n = 283 No data about gender or mean age | Data were collected three times during the nursing studies, one measurement per year. | Emotional exhaustion significantly increased during nursing studies. Depersonalisation scores increased, but the differences were not statistically significant. Personal accomplishment scores did not change. | B/2b |
Pelit-Aksu et al., 2020. Turkey [25] | Randomised controlled trial. | Control group (n = 78) Intervention group (n = 67) 84.8% of the sample was female. The mean age was 21.99. | Students saw a demonstration about a progressive muscle relaxation exercise, and then they performed it for 30 minutes. The students tensed and relaxed the muscle groups in the hands, arms, neck, shoulder, chest, stomach, hips, feet, and fingers and all muscles in the face and body, in sequence. During the PMRE, the students listened to the audio instructions and applied the exercises exactly according to these audio instructions. They were told to perform this kind of routine before sleep at least four times per week. They received verbal direction instructions on their phones. | Burnout scores significantly decreased after three weeks in both groups, but the decrease was greater in the intervention group (3.64 to 2.51) than in the control group (3.31 to 3.02). The differences between groups in favour of the experimental group were statistically significant (2.51 vs 3.02) | A/1b |
Rudman and Gustavsson, 2012. Sweden [33] | Quantitative longitudinal study (cohort study) | n = 1702. 91% of the sample was female. The mean age was 28. | Measurement over the three years of higher education. | Emotional exhaustion and depersonalisation increased over the years in nursing higher education. The increase was greater in D than in EE. The burnout prevalence increased from 29.7% to 36.9% in the second year and 41% in the third year. Changes in EE predicted health problems and lower levels of satisfaction with life. Higher D and its increasing predicted lower levels of engagement and occupational preparedness. | B/2b |
Watson et al., 2008. China [34] | Quantitative longitudinal study (cohort study) | n = 158. 82.3% of the sample was female. The mean age was 19.1. | Two measurements. At the start of the studies and after seven months. | Higher levels of burnout were reported at the second measurement, which is largely explained by neuroticism and emotion-oriented coping. EE increased from 22.6 to 24.5. D increased from 10.4 to 11.5 PA significantly decreased from 29.1 to 27. | B/2b |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gómez-Urquiza, J.L.; Velando-Soriano, A.; Martos-Cabrera, M.B.; Cañadas, G.R.; Albendín-García, L.; Cañadas-De la Fuente, G.A.; Aguayo-Estremera, R. Evolution and Treatment of Academic Burnout in Nursing Students: A Systematic Review. Healthcare 2023, 11, 1081. https://doi.org/10.3390/healthcare11081081
Gómez-Urquiza JL, Velando-Soriano A, Martos-Cabrera MB, Cañadas GR, Albendín-García L, Cañadas-De la Fuente GA, Aguayo-Estremera R. Evolution and Treatment of Academic Burnout in Nursing Students: A Systematic Review. Healthcare. 2023; 11(8):1081. https://doi.org/10.3390/healthcare11081081
Chicago/Turabian StyleGómez-Urquiza, José Luis, Almudena Velando-Soriano, María Begoña Martos-Cabrera, Gustavo R. Cañadas, Luis Albendín-García, Guillermo A. Cañadas-De la Fuente, and Raimundo Aguayo-Estremera. 2023. "Evolution and Treatment of Academic Burnout in Nursing Students: A Systematic Review" Healthcare 11, no. 8: 1081. https://doi.org/10.3390/healthcare11081081