Literature underscoring the study methodology

Various studies on the incidence of and contributing factors to burnout were found in the literature both nationally and internationally. The methodologies of these studies are

33 presented in Table 2.4. The current study included all types of therapists (including the assistant) and their managers whereas the international studies focused mainly on physiotherapists and occupational therapists. Two of the international studies (Girgis, et al, 2009; Kowalski et al, 2010) included other health care professionals (e.g. nurses, nursing assistants, social workers, disability support workers and health professionals who specialise in the field of oncology). It is uncertain if the disability support workers are similar to the therapy assistant referred to in this study or included the therapy assistant. Only Donohoe et al (1993) and Schlenz et al (1995) focused on inpatient rehabilitation as did the current study. It is uncertain if these units were public or private units.

The participant numbers of these studies varied between 40 and 740 and the number of participants in the current study is thus small in comparison. The researcher did not do sampling for this reason.

Of the thirteen studies, six used a mixed methods design and seven used a quantitative study design. The researcher chose a mixed method design in order to enrich the study findings. Ten studies made use of the MBI or an adapted version of it. That combined with the MBI’s proven reliability and validity made it the instrument of choice with which to determine the prevalence of burnout in the current study in spite of it being expensive. By including interview schedules and a qualitative component the researcher was able to not only establish the prevalence of burnout but also to establish the factors which contribute to burnout and possible solutions to the problem in the study setting.

34

Table 2.5 South African and international burnout studies underscoring the study methodology

Study Setting Design Population Sampling Participants Instruments

South African studies

Military nurses (Van Wijk, 1997)

1 Military base hospital, sick bays in isolated areas & larger centres

Mixed qualitative and quantitative

94 fulltime nurses Volunteer 46 Military nurses Questionnaires & semi- structured interviews

Trauma nurses (Spies, 2004)

Eight trauma units in Pretoria

Quantitative Nurses employed at level 1 & 2 trauma units (103

questionnaires distributed)

Convenient 53 Trauma unit

nurses

MBI, Nursing stress survey & biographical questionnaire

Hospice workers (Sardiwalla, Van den Berg & Esterhuyse, 2007)

Hospices in Bloemfontein & Ladysmith

Quantitative All available hospice workers in setting (no number given)

Not described 78 Hospice workers MBI, Biographical questionnaire, Cope Scale, Experience of Work and Life Circumstances questionnaire

International studies

35 Pacific Northwest of the USA (Schlenz et al, 1995) Ten rehabilitation units in Pacific Northwest Mixed qualitative and quantitative All Occupational Therapists & physiotherapists that treat patients with head injuries

None 21 Occupational

Therapists & 19 physiotherapists

40 in total

MBI & biographical info Survey which included three open-ended questions Massachusetts (Donohoe et al, 1993) Seven inpatient rehabilitation hospitals Mixed qualitative and quantitative All physiotherapists treating inpatients in the setting

None 129 Physiotherapists MBI, demographic data questionnaire, Interview schedule

Cypriot (Pavlakis et al, 2010)

Public & private sector

Mixed qualitative and quantitative

383 Physiotherapists doing rehabilitation of head injured patients

Stratified random 172 Physiotherapists MBI, demographic data questionnaire that included several aspects related to burnout & occupational stress and self image

Germany (Kowalski et al, 2010)

Sheltered workshop and five homes for disabled persons

Quantitative 308 Professionals working in the care of persons with

intellectual & physical disabilities

Not described 175 Professionals MBI-GS &

questionnaires which measured variables based on certain scales

36

Madrid, Spain (Gutiérrez, Rodriguez, Puente, Costa, Recio, Cerro & Cuadros, 2004) Institutions in Madrid Autonomous Region that offered occupational therapy service Mixed qualitative and quantitative Occupational Therapists working in clinical practice

(Number not given)

Not described 110 Occupational Therapists

Specific stressors scale & Nursing Professional Burnout Questionnaire Japan (Ogiwara & Hayashi, 2002) Physiotherapists employed in Ishikawa Prefecture

Quantitative 243 Physiotherapists 127 Physiotherapists Demographic

questionnaire, MBI (Japanese version)

South Australia (Scutter & Goold, 1995)

Physiotherapists employed in Southern Australia

Quantitative 122 Physiotherapists who graduated in the last five years

None 81 Physiotherapists MBI & demographic and stressors questionnaire

Norway (Mandy et al, 2004)

Norwegian physiotherapists

Quantitative Total number not given

200 Questionnaires mailed

Random 127 Physiotherapists Bergen Inventory, General Self-Efficacy Scale & demographic questionnaire Posted questionnaires Australia (Girgis et al, 2009) Multi-disciplinary oncology health professionals in Australia multidisciplinary groups Mixed qualitative and quantitative

All the members of the Clinical Oncological Society of Australia (1157) None 740 Health professionals Demographic questionnaire, MBI, interview schedules and Kessler Psychological Distress Scale

37

Turkey (Gulalp, Karcioglu, Sari & Koseoglu, 2008)

Three state hospitals in Southern Turkey

Quantitative All healthcare workers 90 staff members

(38 emergency physicians, 40 nurses and 12 nurses’ aids)

38 2.4 Summary

In this chapter the literature findings on burnout were addressed. The concept of burnout in relation to health-care professionals was first suggested in 1974. After years of research there is no generally agreed-on definition of burnout. However, Maslach and Jackson’s research on burnout is regarded as the most influential and their three elements of burnout: emotional exhaustion, development of depersonalization and reduced accomplishment generally form the basis of burnout research.

Burnout is not officially recognised as a mental disorder and is not included in the ICD-10 classification. Burnout has a number of similarities with other emotional disorders but is different from other clinical syndromes such as anxiety, depression and stress. The fatigue component overlaps with disorders such as compassion fatigue, vital exhaustion and depression.

Burnout is caused by a combination of risk factors that interact with each other. Through research a risk profile for burnout has been developed. The symptoms and effects of burnout vary. There has been ample evidence to show that burnout presents a serious threat to an employee’s health and working ability and has a harmful influence on an individual’s emotional, behavioural, physical and cognitive functioning. It also has a negative effect on the functioning of the organisation. A few studies indicated that burnout has a negative effect on patient outcomes, but more research needs to be done in this regard.

It has been stressed by literature that burnout must be treated in a pro-active and preventative way and the literature discusses various burnout management and intervention strategies in this regard for both the company and the individual. The burnout syndrome is resistant to spontaneous recovery. Health promotion is of increasing importance and must be integrated into the culture of organisations.

The severity and extent of the problem is huge with negative current and future impact on work place finances and staff turnover both in South Africa and internationally.

39 CHAPTER 3

Methodology 3.1 Introduction

In Chapter Three the methodology of the study is presented. The chapter focuses on the aim, objectives, design, setting, data collection and data analysis procedures used in the study. It also includes information on the study population, the pilot study and the measuring instruments used in the study. Finally ethical issues, as well as the rigour of the data, are explored.