Analyzing Research Articles on Nurse Burnout during COVID-19

A. Clinical Question

1. Problem Description
   Burnout, a state of emotional/physical/mental exhaustion due to prolonged involvement
   in work, is increasingly being labeled a primary health concern among healthcare workers
   (HCWs), including nurses, physicians, pharmacists, and lab technicians. Although the exact
   number is difficult to report, evidence suggests that burnout has affected a significant proportion
   of healthcare workers, particularly nurses who are often deployed as frontline workers, since the
   COVID-19 pandemic first spread to the US in 2020 (Zareei et al., 2022).
2. Significance of the Problem
   Burnout threatens the well-being of healthcare workers, patients, and healthcare
   organizations. For nurses, burnout due to emotional, physical, and mental exhaustion can
   decrease job satisfaction, motivation/morale, and workplace engagement/participation; it can
   also lead to increased conflicts and physical and mental problems, including depression and
   anxiety. For patient care, nurse burnout can lead to poor quality and safety of care and,
   subsequently, medical errors and other adverse outcomes like the increased length of patient
   hospital stay and cost of care. Medical errors can be compounded by other factors like nurse
   shortages, lack of coordination and effective communication, and conflicts. For healthcare
   organizations, high incidences of burnout can lead to high turnovers and, if unmonitored, can
   lead to staffing shortages, increased cost of production, reputational damage, and reduced
   revenues (Khasne et al., 2020).
3. Purpose of the Paper

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This paper’s purpose is to interpret the two articles [Khasne et al., (2020) and Zareei et
al., 2022)] identified as most integral to exploring and understanding the selected topic: nurse
burnout during the COVID-19 pandemic. The paper will comprise two parts: filling of the
“matrix table” and “description of findings.”

B. Evidence Matrix Table Matrix

Check the “The Matrix Table” in Appendix A.

C. Description of Findings

1. Comparison/Contrast of the Variables in the Two Studies
   The two articles use the same dependent (burnout) and independent (COVID-19)
   variables. They answer the question: What is the prevalence of burnout (DV) in healthcare
   workers in India due to COVID-19 (DV)?
2. Study Design and Procedures
   Both studies use a quantitative approach, meaning numerical data is collected, analyzed,
   interpreted, and applied to the general population. The difference is that Khasne et al. (2020)
   employ a questionnaire-based survey to collect responses from 2,026 healthcare workers in
   Indian healthcare facilities, while Zareei et al. (2022) use a systematic review design. For the
   first study (Khasne et al., 2020), a questionnaire was emailed to healthcare workers through
   Facebook’s WhatsApp Messenger, and voluntary participation was sought from participants. The
   researchers then analyzed burnout in client, work, and personal-related (COVID-19 pandemic-
   related) spheres or domains. In the second study (Zareei et al., 2022), PRISMA guidelines were
   used to search relevant articles published between 01/02/2022 and 30/10/2022 in five databases:
   five databases: Science Direct, Web of Science, Google Scholar, Scopus, and PubMed. The

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relevant data was then extracted, and burnout severity/prevalence was analyzed among nurses; p-
values were also calculated.

3. Participant Demographics and Information
   In the first study (Khasne et al., 2020), burnout prevalence due to COVID-19 was
   measured in all healthcare workers (HCWs), including nurses, doctors/physicians, and
   paramedics (administrative staff, ward boys, pharmacists, physiotherapists, dieticians,
   paramedics). The questionnaire sent to participants contained demographic information about the
   working environment, gender, age, and job profile. Participants recruited were 21 years and
   above. The second study (Zareei et al., 2022) examines burnout prevalence rates due to COVID-
   19 among nurses only and not all healthcare workers. Inclusion criteria if they were written in
   English, were reports of original studies, had been published between 01/02/2022 and
   30/10/2022, and were relevant to the topic (prevalence of nurse burnout during the COVID-19
   crisis).
4. Instruments Used, Including Their Reliability and Validity
   Khasne et al. (2020) used a questionnaire (five general questions in three burnout
   domains) to collect their survey data; responses were provided on a 5-point Likert scale for
   intensity (from a “very low degree” to a “very high degree” and frequency (from “almost never
   or never” to “always.” The researchers retrieved from Google sheets and analyzed it using the
   SPSS (IBM Statistics Version 21). On the other hand, Zareei et al. (2022) used the PRISMA
   guidelines and EndNote software to search, extract, and analyze relevant articles for their review.
   For both studies, the data collection (questionnaire and PRISMA) and analysis (SPSS and
   EndNote software) instruments are reliable and valid because they are standard statistical tools.
5. How the Research Findings Provide Evidence to Support the Clinical Problem

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Both studies provide adequate, valid, and reliable evidence to support the claim that
COVID-19 contributed to or increased burnout rates among clinical workers. For example,
Khasne et al. (2020) found prevalence rates of work-related burnout and personal burnout to be
26.9 percent (544 participants) and 44.6 percent (903), respectively. Another 52.8 percent
(1,069) participants reported COVID-19-related burnout. Younger HCWS (21-30 years) and
female participants (p < 0.01) also experienced higher work-related and personal burnout. A
systematic review by Zareei et al. (2022) also revealed similar outcomes. Out of the seven
articles that met the inclusion criteria, three (42.86 percent) had high, while four (57.14 percent)
had moderate nurse burnout levels during the pandemic.

6. Next Steps: Two Questions that can Help Guide the Group’s Work
7. What underlying factors contributed to high nurse burnout rates?
8. What are the impacts of high nurse burnout rates on patient care, nurses, and healthcare
   organizations?

D. Conclusion

Employee burnout in the healthcare industry is becoming a huge concern for hospitals
and other healthcare organizations because of the negative impacts it poses on the quality, safety,
and cost of patient care, the well-being and performance of clinicians, and the organization’s
reputation and bottom line. During COVID-19, evidence from this analysis reveals that
healthcare workers, including nurses, experienced a spike in burnout rates due to emotional,
mental, and physical exhaustion.

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References

Khasne, R. W., Dhakulkar, B. S., Mahajan, H. C., & Kulkarni, A. P. (2020). Burnout among
Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-
based Survey. Indian Journal of Critical Care Medicine: Peer-reviewed, Official
Publication of Indian Society of Critical Care Medicine, 24(8), 664-671.
https://doi.org/10.5005/jp-journals-10071-23518
Zareei, M., Tabanejad, Z., Oskouie, F., Ebadi, A., & Mesri, M. (2022). Job burnout among
nurses during COVID-19 pandemic: A systematic review. Journal of Education and
Health Promotion, 11. https://doi.org/10.4103/jehp.jehp_797_21

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Appendix

Appendix A: Evidence Matrix Table
Article

References

Purpose
Hypothesis
Study Question(s)

Variables
Independent(I)
Dependent(D)

Study Design

Sample
Size &
Selection

Data Collection
Methods

Major Finding(s)

Smith, L. (2013).
What should I eat? A focus for those
living with diabetes. Journal of Nursing
Education, 1 (4) 111-112.

How do educational support groups effect dietary
modifications in patients with diabetes?

D-Dietary modifications
I-Education

Qualitative N- 18

Convenience sample-selected
from local support group in
Pittsburgh, PA

Focus Groups Support and education improved
compliance with dietary modifications.

1 Khasne, R. W., Dhakulkar, B. S.,
Mahajan, H. C., & Kulkarni, A. P.
(2020). Burnout among Healthcare
Workers during COVID-19 Pandemic in
India: Results of a Questionnaire-based
Survey. Indian Journal of Critical Care
Medicine: Peer-reviewed, Official
Publication of Indian Society of Critical
Care Medicine, 24(8), 664-671.
https://doi.org/10.5005/jp-journals-
10071-23518

What is the prevalence of burnout in healthcare
workers (HCWs) in India due to COVID-19?

D – Burnout
I – COVID-19

Quantitative N – 2,026 HCWs
Simple random sampling –
All Indian healthcare workers
(HCWs) aged 21 and above
were eligible to participate in
the survey

Questionnaire The prevalence rates of work-related
burnout and personal burnout were 26.9
percent (544 participants) and 44.6 percent
(903), respectively. Another 52.8 percent
(1,069) participants reported COVID-19-
related burnout. Younger HCWS (21-30
years) experienced higher work-related and
personal burnout. The prevalence rates for
both burnouts were also higher among
females (p < 0.01).

2 Zareei, M., Tabanejad, Z., Oskouie, F.,
Ebadi, A., & Mesri, M. (2022). Job
burnout among nurses during COVID-
19 pandemic: A systematic review.
Journal of Education and Health
Promotion, 11.
https://doi.org/10.4103/jehp.jehp_797_2
1

What is the prevalence of burnout among nurses
caring for COVID-19 patients?

D – Burnout
I – COVID-19

Quantitative N – 7 articles
The PRISMA model – a
Boolean search was
performed to extract articles
published between
01/02/2020 and 30/10/2020
from five databases: Science
Direct, Web of Science,
Google Scholar, Scopus, and
PubMed.