Effectiveness of Guided Imagery on Burnout Syndrome among Staff Nurses Working in Dhiraj General Hospital at Piparia, Vadodara

 

Daxesh K. Patel1, Mr. Suresh V2

1Student, Sumandeep Nursing College, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India.

2Associate Professor, Sumandeep Nursing College, Vidyapeeth, Piparia, Vadodara, Gujarat, India.

*Corresponding Author’s Email: pateldaxesh5@gmail.com, vss_ssh@yahoo.co.in

 

ABSTRACT:

Background: The term "burnout" is related to a situation arising increasingly more often among the professionals performing their duties by way of a long-term, direct, people-to-people relationship, which includes all healthcare professionals. This study is Aims and Objective: 1] To determine the level of burnout syndrome among staff nurses in dhiraj general hospital.2] To assess the effectiveness of guided imagery on burnout syndrome among staff nurses in dhiraj general hospital.3] To find out association between the level of burnout syndrome with the selected demographic variables. Material and Method: Pre experimental one group pre-test – post-test research design, and non-probability purposive sampling technique was adopted to achieve the goal of the study. The tool consists of two parts. First part consist demographic data of the sample and second part consist of standardized tool maslach burnout inventory. The sample was 60 staff nurses working in dhiraj general hospital at piparia, Vadodara. Results: The data was collected by using maslach burnout syndrome. Descriptive and inferential statistics was used for analysis. Result revealed that In the pre-test mean score and SD was 77.88 + 15.15 and post-test means score and SD was 66.30 + 9.09.WhilePaired mean difference score was 11.58. The post-test level of burnout mean score is significantly lower than the pre-test level of burnout mean score. The ‘t’ calculated value 9.97 is more than tabulated value 3.4632 at P<  0.001 level of significance. Conclusion: The ‘t’ test was computed between pre-test and post-test score indicate that the mean post-test burnout score is significantly lower than the mean pre-test burnout score among staff nurses exposed to guided imagery. Hence it is indicated that guided imagery was effective.

 

KEYWORDS: Effectiveness, guided imagery, Burnout syndrome, Staff Nurse.

 

 

 


The "burnout" is related to a situation arising increasingly more often among the professionals performing their duties by way of a long-term, direct, people-to-people relationship, which includes all healthcare professionals. This study is aimed at determining the level of the Burnout syndrome and effectiveness of guided imagery on burnout syndrome the three components involved there in (emotional exhaustion, depersonalization, and fail in personal achievement) among the nursing staff.

Guided imagery uses the power of imagination to evoke positive images to stimulate healing. It involves thinking in pictures to contact a person’s inner reality. Thinking in pictures invokes all of the senses: hearing, seeing, tasting, smelling and touching as well as sensing the body’s position and movement and even emotions. This guided imagery exercises are used for relaxation, where the exercises last seconds to minutes. It uses a body mind connection which closely links to healing.

 

NEED FOR STUDY:

The term burnout is becoming more and more commonly heard in the field of medical professional, and I often see staff nurses in my practice that show many symptoms of burnout. So what exactly is it?  Burnout involves a psychological, emotional, and sometimes physical withdrawal from the activity in response to excessive stress or dissatisfaction. What’s most important to know about burnout is that it’s very complex in how it develops both physically and emotionally. However, burnout can be relatively easy to manage and avoid. This we will look at some research and statistics, symptoms, and helpful coping strategies for burnout.14 Personal and professional demands make nurses highly stressed. Burnout is common in nursing profession as the result of overwork, repetitive work and monotony in works, which may leads to physical as well as the mental exhaustion in nursing profession. Studies showed, among the world countries Asia has the highest incidence of staff burnout. Consequences of burnout range from emotional isolation, less productivity in work, relationship problems, substance abuse to suicide.18

 

 

Burnout was recognized as an occupational risk for professions that involve health care, education and human services; that is to say, it particularly affects professionals in the area of services, or care-givers, when they are in direct contact with the users. From this aspect, the work of nursing professionals is pointed out. Burn out is a job-related condition involving the feelings of emotional exhaustion, depersonalization and reduced emotional accomplishment. About 30 to 50 percent of work force is exposed to psychological overload at work resulting in occupational stress and burnout. European member states have reported burnout prevalence of 29 percent, and in US 75 percent of workers admit that their jobs are stressful and pressure of work is steadily increasing. In India the burnout prevalence is found to be 23 to 30 percent. It affects persons involved in various professional and stressful activities including the work in intensive care unit. 20

 

According to the Ministry of Social Security, in 2007, 4.2 million persons were laid off work, and of these, 3,852 were diagnosed with Burnout Syndrome.22 We found that majority of the nursing staff at our hospital were in a state of burnout with high frequency of EE and DP. Only a quarter of the surveyed staff felt that they had some level of PA. Age and working away from their home countries were the important predictors in the development of BS in nurses. We believe that working conditions have to be improved to develop strategies to cope and alleviate stressful situations.23 The reported cases here, we used survey data collected from 53,846 nurses in six countries—the U.S., Canada, U.K., Germany, New Zealand, and Japan—to investigate the association between nurse burnout and nurse-rated quality of care. The instruments and questionnaires in each of these surveys included measures of many variables hypothesized to be involved in the relationship between burnout and perceptions of quality of care.24

STATEMENT OF THE STUDY:

“Effectiveness of guided imagery on burnout syndrome  among staff nurses working in Dhiraj General Hospital at Piparia, Vadodara

 

OBJECTIVE:

1)   To determine the level of burnout syndrome among staff nurses in dhiraj general hospital.

2)   To assess the effectiveness of guided imagery on burnout syndrome among staff nurses in dhiraj general hospital.

3)   To find out association between the level of burnout score with the selected demographic variables.

 

HYPOTHESIS:

*     H1:- The mean burnout post-test score will be significantly lower than the mean pre-test burnout score among the sample.

*     H2:- There will be a significant association between pretest levels of burnout score with selected demographic variables. 

 

ASSUMPTIONS

1.    Nurses may prone to get burnout syndrome.

2.    Guided imagery may reduce the burnout syndrome.

3.    Guided imagery has no adverse effect on the staff nurses.

 

OPERATIONAL DEFINITIONS EFFECTIVENESS:

In this study, effectiveness refers to the extent to which practicing guided imagery has achieved the results as expressed in the posttest in terms of reduction burnout syndrome of staff nurses working in dhiraj general hospital. It means the extent to which an action produces an intended outcome.

 

GUIDED IMAGERY:-

It is the purposeful use of imagination to achieve relaxation or, direct attention away from undesirable sensations. In this study therapist makes the staff nurses to relax in a comfortable position and environment and guides the staff nurses through a sequence of pleasant situations for a particular time. When the staff nurses imagine the pleasant situations, it might bring changes in the burnout level after repetitive use.

 

BURNOUT SYNDROME:-

Burnout is a psychological term that refers to long-term exhaustion and diminished interest in work. Burnout has been assumed to result from chronic occupational stress. Burnout refers to feeling of physical exhaustion and lack of   emotional strength to invest in work, which leads to emotional isolation and less productivity at work place. In this study burnout refers to level of psychological and  physical fatigue, quantity and quality of the burden at work ,level of motivation, role conflicts ,level of responsibility for patient and other staff members and level of social and professional support of the staff nurses and will be measured by maslach burnout inventory.

 

 

 

STAFF NURSES:-

The nurses who are registered and qualified with ANM, Diploma and B.sc nurse who are working in the dhiraj general hospital at piparia, Vadodara.

 

Conceptual framework:

Modified conceptual framework based on Roy’s adaptation theory.


 

 


RESEARCH METHODOLOGY:

Methodology of research indicates the general pattern of organizing the procedure for the empirical study together with the method of obtaining valid and reliable data for problem under investigation. The methodological decision paves crucial implications for validity and credibility of the study findings. Methodology of research indicates the general pattern for organizing the procedure for the empirical study together with the method of obtaining valid and reliable data for an investigation.

 

RESEARCH APPROACH:

A quantitative research approach is adopted for the study.

 

RESEARCH DESIGN:

The pre –experimental design chosen for the study.

 

Systematic representation of research design schematic representation of research design is given below:

GROUP

PRE-TEST

INTERVENTION

POST-TEST

Staff nurse working in dhiraj general hospital

On level of burnout syndrome among staff nurse working in  dhiraj general hospital

Guided imagery

On level of burnout syndrome among staff nurse working in  dhiraj general hospital

 

O1

X

O2

 

Key:

O1:-       (1) Demographic variables of staff nurse working in dhiraj general hospital

(2) Administration maslach burnout inventory to determine the pre-test level of burnout syndrome among staff nurses in dhiraj general hospital.

X:-         Administration Of Guided Imagery On Burnout Syndrome Among Staff Nurses By Using Maslach Burnout Inventory (MBI).

O2:-       Administration maslach burnout inventory to determine the post-test level of burnout syndrome among staff nurses in dhiraj general hospital.

 

RESEARCH VARIABLES:

Ø INDEPENDENT VARIABLES:

Guided imagery is the independent variable in this study.

 

Ø DEPENDENT VARIABLES:

In this study level of burnout syndrome is the dependent variable.

 

EMOGRAPHIC VARIABLE:

Age, sex, religion, professional, qualification, marital status, family income clinical experience in years, job description, area of wok, and previous exposure of any psychotherapy.

 

SETTING OF THE STUDY

The study will be conducted in the Dhiraj General Hospital at Piparia, Waghodia, Vadodara.

 

TARGET POPULATION:

In this study, the target population consisted of staff nurses with burnout syndrome who are working in Dhiral General Hospital Piparia, Vadodara.

 

SAMPLE SIZE:

The sample for the present study comprises of 60 staff nurses who fulfilled the sampling criteria and expressed willingness to participate in the study.

 

SAMPLING TECHNIQUE:

Non probability purposive sampling technique

 

CRITERIA FOR THE SELECTION OF SUBJECT:

Ø Inclusion criteria:

-      Staff nurses age group of 18-58 years.

-      Staff nurses both male and female.

-      Staff nurses who are willing participate in the study.

 

Ø Exclusion criteria:

-      Staff nurses who were using any supportive therapy.

-      Staff nurses who had sensory impairment.

 

 

DESCRIPTION OF THE TOOL:

Section A:

Demographic data which includes Age, sex, religion, professional qualification, marital status, family income, clinical experience in years, job description, and area of work and previous exposure of any psychotherapy.

 

Section B:

Maslach burnout inventory scale consist of 21 statements to measures the level of burnout syndrome had by sample. The response alternatives were 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. These responses score as 0, 1, 2, 3, 4, 5 and 6 for each statement.

 

SCORING KEY

Dimension

Low level

Moderate level

High level

Emotional exhaustion

17 or less

18 and 29 inclusive

over 30

Depersonalization

5 or less

6 and 11 inclusive

12 and greater

Personal achievement

33 or less

34 and 39 inclusive

greater than 40

 


 

RESULT

Table 1: frequency and percentage distribution of staff nurses based on their demographic variables. N=60

Sr. no

Demographic variables

Characteristics

Frequency

Percentage (%)

1

Age in years

18-28 years

26

43.3

28-38 years

25

41.7

38-48 years

7

11.7

48 and above

2

3.3

2

Gender

Male

13

21.7

Female

47

78.3

3

Religion

Hindu

44

73.3

Christian

7

11.7

Muslim

9

15.0

Others

0

00

4

Professional Qualification

ANM

20

33.3

GNM

26

43.3

B.SC NURSING

14

23.3

M.S.NURSING

0

00

5

Marital status

Single

18

30.0

Married

40

66.7

Divorced

2

3.3

Separated/widowed

0

00

6

Monthly Income (Rupees)

5000-10000

0

00

10001-15000

24

40.0

15001-20000

24

40.0

20000 and above

12

20.0

7

Clinical experience in years

0-5 years

13

21.7

6-10 years

35

58.3

11-15 years

6

10.0

16 years and above

6

10.0

8

Job Description

Head nurse

8

13.3

Staff nurse

52

86.7

9

Area Of Work

OT

6

10.0

Labor room

6

10.0

ICU

8

13.3

ward

40

66.7

10

Previous exposure of psychotherapy

Yes

2

3.3

No

58

96.7

 


THE DATA PRESENTED IN THE TABLE INDICATE RESULT AS FOLLOW.

Ø Age in years:

In the present study, age wise distribution revealed that out of 60 staff nurses, 26 (43.3%) of the subject were in the age group of 18-28 years, 25 (41.7%) of them were in the age group of 28-38 years, 7 (11.7%) of them were in the age group of 38-48 years and 02 (3.3%) of them were in the age group of 48 years and above.

 

Ø Gender:

Gender wise distribution of the subjects indicated that 13 (21.7%) were male and 47 (78.3%) were females.

 

Ø Religion:

Religion wise distribution of the subjects indicated that 44 (73.3%) were Hindus and 7 (11.7%) were Christians and 9 (15%) were Muslims and remaining are 00 (00%) were others.

 

Ø Professional Qualification:

Professional qualification of the subject that indicated majority 26 (43.3%) were GNM, 20 (33.3%) were ANM, 26 (43.3%) were GNM, 14 (23.3%) were B.SC NURSING, and 00 (00%) were M.SC NURSING.

 

Ø Marital status:

In context to marital status of the subject that indicated 18 (30.0%) were single 40 (66.7%) were married 2 (3.3%) were divorced and 00 (00%) separated/widowed.

 

Ø Monthly Income (Rupees):

Considering the monthly income in rupees of the subject that indicated, majority 24 (40%) of subjects had 15000-20000 as their monthly income, 24 (40%) had 10001-15000 and 12 (20%) had 20000 and above and 0 (00%) had 5000-10000 as monthly income.

 

Ø Clinical experience in years:

With regard to clinical experience 13 (21.7%) had 0-5 years of experience, while 35 (58.3%) of them had 6-10 years of experience, 6 (10%) had 11-15 years of experience and 6 (10%) had above 16 years of experience. (figure.6)

 

Ø Job Description:

In relation to job description of the subject that indicated, 8 (13.3%) were head nurse and 52 (86.7%) were staff nurse.

 

Ø Area Of Work:

In relation to area of work of the subject that indicated, 6 (10%) had OT area, 6 (10%) had labor room, 8 (13.3%) had ICU, and majority of staff nurses 40 (66.7) had ward area.

 

Ø Previous exposure of psychotherapy:

In relation to previous exposure of psychotherapy of the subject that indicated, majority of staff nurses 58 (96.7%) had no any Previous exposure of psychotherapy and 2 (3.3%) had exposure of psychotherapy

 


Table 2: percentage distribution of dimension wise score level of burnout syndrome among staff nurses. N= 60

Dimension

Level of Burnout

PRE TSET

POST TEST

Frequency

Percentage (%)

Frequency

Percentage (%)

Emotional exhaustion

Low level burnout

13

21.7

40

66.7

Moderate level burnout

35

58.3

20

33.3

High level burnout

12

20.0

00

00

Total

60

100.0

6

100.0

Depersonalization

Low level burnout

0

0

1

1.7

Moderate level burnout

12

20.0

27

45.0

High level burnout

48

80.0

32

53.3

Total

6

100

60

100.0

Personal Achievement

Low level burnout

1

1.7

24

40.0

Moderate level burnout

31

51.7

29

48.3

High level burnout

28

46.7

7

11.7

Total

60

100.0

60

100.0

 


The pre-test depicts emotional exhaustion that prior to the administration of guided imagery majority of 35 (58.3%) staff nurses had moderate level of burnout (score:18-29 inclusive)  while 12 (20%)  staff nurses had high level of burnout (score: over 30) and 10 (21.7%) staff nurses had low level of burnout (score: 17 or less). while The post-test depicts the majority of 40 (66.7%) staff nurses had low level of burnout (score: 17 or less) while 20 (33.3%)  staff nurses had moderate level of burnout (score:18-29 inclusive)  and 00 (00%) staff nurses had high level of burnout (score: over 30) in particular study. The pre-test depicts depersonalization that prior to the administration of guided imagery majority of 48 (80%) staff nurses had high level of burnout (score: 12 and greater than) while 12 (20%) staff nurses had moderate level of burnout (score: 6-11 inclusive) and 00 (00%) staff nurses had low level of burnout (score: 5 or less). While the post-test depicts the majority of 32 (53.3%) staff nurses had high level of burnout (score: 12 and greater than) while 27 (53%) staff nurses had moderate level of burnout (score: 6-11 inclusive) and 01 (1.7%) staff nurses had low level of burnout (score: 5 or less) in particular study. The pre-test depicts personal achievement that prior to the administration of guided imagery majority of 31 (51.1%) staff nurses had high level of burnout (score: 33 or less)  while 28 (46.7%) staff nurses had moderate level of burnout (score:34-39 inclusive) and 1 (1.7%)  staff nurses had low level of burnout (score: 40 and greater than). while the post-test depicts the majority of 29 (48.3%) staff nurses had moderate level of burnout (score:34-39 inclusive) 24 (40%)  staff nurses had low level of burnout (score: 40 and greater than) and 07 (11.7%) staff nurses had high level of burnout (score: 33 or less) in particular study.

 


 

 

Table 3: Significance of the difference between pre and post-test knowledge score N=60

Pre-test score

Mean (%)

Post-test score

Mean

(%)

Mean difference

Paired 't'  value

Mean

SD

Mean

SD

77.88

15.15

61.80

66.30

9.09

52.61

11.58

9.97

*Significant; DF = 59; table value = 3.4632 (at p<0.001 level)

 


Table 3 represents that mean pre-test and mean post-test level of burnout  score with Maximum possible score, Standard Deviation, Mean difference and paired ‘t’ value. Level of burnout score is with the maximum possible score of 126. Mean pre-test is 77.88, SD is 15.15 and the mean score percentage is 61.80%. Mean post-test is 66.30, SD is 9.09 and the mean score percentage is 52.61% and comparison between pre and post-test level of burnout score among staff nurses shows paired ‘t’ value as 9.97.

 

 

MEAN, STANDARD DEVIATION, MEAN DIFFERENCE AND PAIRED ‘T’ VALUE OF PRE- TEST AND POST TEST BURNOUT SCORES.

 


 

Table 4:  comparison of mean, sd, and mean% of pre-test and post-test dimension wise level burnout score among staff nurses N = 60

Dimension

No. of Statement

Max Score

Burnout  Scores

Paired ‘t’ test

Pre-test (x)

Post-test (y)

Effectiveness (x-y)

Mean

SD

Mean %

Mean

SD

Mean %

Mean

SD

Mean %

Emotional exhaustion

6

36

24.85

5.51

69.02%

15.93

4.75

44.25%

8.92

0.76

24.77%

15.480*

Depersonalization

7

42

20.61

8.69

49.07%

12.25

6.13

29.16%

8.36

2.56

19.90%

10.157*

Personal  Achievement

8

48

31.96

3.78

66.58%

38.11

3.80

79.39%

6.15

0.02

21.81%

8.669*

TOTAL

21

126

77.42

17.98

61.44%

66.29

14.68

52.61%

23.43

3.34

18.59

34.306

 

 


Table 4: reveals that comprising of dimension wise level of burnout score among staff nurses mainly three dimensions as mention below.

 

Emotional exhaustion:

Per test table shows the maximum 36 score had a mean of 24.85 with a standard deviation of 5.51 and mean% of 69.02%. While post-test table shows mean of 15.93 with a standard deviation of 4.75 and mean% of 44.25%. And effectiveness shows mean of 8.92 with a standard deviation of 0.76 and mean% of 24.77%.

 

 

 

 

Depersonalization:

Per test table shows the maximum 42 score had a mean of 20.61 with a standard deviation of 8.69 and mean% of 49.07%. While post-test table shows mean of 12.25 with a standard deviation of 6.13 and mean% of 29.16. And effectiveness shows mean of 8.36 with a standard deviation of 2.56 and mean% of 19.90%.

 

Personal Achievement:

Per test table shows the maximum 48 score had a mean of 31.96 with a standard deviation of 3.78 and mean% of 66.58%. While post-test table shows mean of 38.11 with a standard deviation of 3.80 and mean% of 79.39. And effectiveness shows mean of 6.15 with a standard deviation of 0.02 and mean% of 21.81%.


 

Column diagram representing the dimension wise mean%.

 

 


Table 5: associations of pre test burnout score among staff nurses with selected demographic variables N = 60

Sr.No

Demographic variables

Pre-test

Total

Chi square(X2)

df

Association

Scores which falls at Median and Above

Scores which falls below  the Median

calculated value

Table value  at p < 0.05 level

1

Age in years

18-28 years

10

16

26

11.69

7.82

3

S

28-38 years

17

8

25

38-48 years

7

0

7

48 and above

2

0

2

2

Gender

Male

12

1

13

7.21

3.84

1

S

Female

24

23

47

3

Religion

Hindu

24

20

44

5.28

5.99

2

NS

Muslim

7

0

7

Christian

5

4

9

4

Professional Qualification

ANM

7

13

20

15.69

5.99

2

S

GNM

23

3

26

B.SC NURSING

6

8

14

5

Marital Status

Single

2

16

18

25.92

5.99

2

S

Married

32

8

40

Divorced

2

0

2

6

Monthly Income (Rupees)

10001-15000

4

20

24

32.22

5.99

2

S

15001-20000

20

4

24

20000 and above

12

0

12

7

Clinical Experience in years

0-5 years

9

4

13

12.74

7.82

3

S

6-10 years

15

20

35

11-15 years

6

0

6

16 years and above

6

0

6

8

Job description

Head nurse

8

0

8

6.15

3.84

1

S

Staff nurse

28

24

52

9

Area Of Work

OT

6

0

6

15.79

7.82

3

S

Labour room

5

1

6

ICU

8

0

8

head nurse

17

23

40

10

Previous exposure of psychotherapy

Yes

2

0

2

1.37

3.84

1

NS

No

34

24

58

 


 

The table reveals that there is significant association between pre- test burnout score and selected demographic variables such as age, sex, professional qualification, marital status, family income, clinical experience in years, job description, and area of work evidenced that there was statistically significant association at P < 0.05 level of except significant religion and previous exposure of psychotherapy there is no significant association between pre- test burnout score. Hence we concluded H2 stated that there will be significant association between the pre-test burnout score with selected demographic variables was accepted.

DISCSSION AND CONCLUSION:

This chapter includes conclusion, implication, limitations and recommendations. The following conclusions were drawn from the finding of the present study. The research approach adopted in the present study is quantitative research approach to measure the effectiveness of guided imagery on burnout syndrome among staff nurses. Effectiveness was assessed by The ‘t’ test was computed between pre-test and post-test score indicate that the mean post-test burnout score is significantly lower than the mean pre-test burnout score among staff nurses exposed to guided imagery. Hence it is indicated that guided imagery was effective.

 

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Received on 03.05.2016         Modified on 21.05.2016

Accepted on 29.06.2016          © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2016; 4(4): 413-420.

DOI: 10.5958/2454-2660.2016.00075.2