Concept analysis is used within healthcare disciplines as a way of understanding and establishing the concept within the boundaries of a particular theory. As concepts are often abstract and detached from reality, thus possessing the ambiguity of meaning, concept analysis allows for a more profound understanding of the matter in relation to objective reality. The chosen concept for this paper is the concept of burnout, which can be accurately addressed in the Conservation of Resources theory (COR). The paper will be divided into the following sections:
- The definition of the selected concept – will provide brief descriptions and discussion of nurse burnout.
- Literature review – will provide information in regards to nurse burnout, conservation of resources theory, and relations between the concept and the theory found in academic studies.
- Defining attributes – will address the three main attributes defining nurse burnout.
- Antecedents and consequences – will discuss factors leading to the discussed concept occurring in real life and the potential consequences of its occurrence.
- Empirical referents – will provide ways of quantitatively measuring the effects of the concept of healthcare.
- Case scenarios – will present three case scenarios, one of which is representing a model case, one – a borderline case, and the last one – a contrast case, in order to demonstrate how the chosen nursing concept differs from the others.
- Theoretical applications of the concept – this section will discuss the importance of concept study in nursing theory and connect nurse burnout with the chosen nursing theory (COR).
Definition of Nurse Burnout
Nurse burnout, also known as compassion fatigue, is a combination of spiritual, emotional, and physical exhaustion from having to care for patients in extreme emotional and physical distress for prolonged periods of time (Alligood, 2017). It is considered to be the primary reason for high turnover rates in hospitals around the world, amounting to 10%-40% of yearly hospital turnover rates, depending on the severity of the working conditions, management, difficulty, and amount of work being performed. The importance of concept analysis for nurse burnout and its attachment to a working nursing theory lies in the ability to understand and mitigate the negative effects of the factor by using the available theoretical framework to develop effective countermeasures that would potentially allow reducing nurse burnout rates and improve quality of care.
Before any conversation regarding nursing burnout and its relation to conservation of resources theory, a thorough understanding of both the theory and the concept is necessary. Alligood (2017) identifies COR as a nursing theory built around stress and the consumption of 4 resources necessary for human functioning, there resources being objects, personal characteristics, conditions, and energies involved in the process. A lack of any of these four resources leads to increased levels of stress, which in turn affects nurses, patients, and health outcomes.
Nurse burnout is noted by many researchers to be one of the critical negative factors influencing patient care. Dall’ora, Griffith, and Ball (2015) define burnout as a depleted emotional state coupled with job dissatisfaction, decreased working capability, and an inability to take care of oneself and others. They adopt this definition in their goal to connect nurse burnout with long shifts, increased workload, and desire to leave.
Many researchers note the connection between nurse burnout and its explanation in the conservation of resources theory. According to Prapanjaroensin, Patrician, and Vance (2017), nurse burnout occurs as a result of nurses’ perceptions of losses of four resources, which are objects, conditions, personal characteristics, and energy. The research states that the perceived loss results in lower work performance, alertness, and the overall quality of care.
Khamisa, Oldenburg, Peltzer, and Ilic (2015), who have performed an examination of over 1200 nurses in Africa, discovered that burnout directly affects health outcomes by forcing nurses to spend extra physical and emotional resources on patients rather than on their own coping mechanisms, support these findings. As a result, they fall victim to exhaustion, social withdrawal, and emotional depletion.
Hunt, Denieffe, and Gooney (2017) view nurse burnout as a result of empathy depletion. Although they do not reference the conservation of resources theory directly, they treat empathy as a finite resource. After a nurse runs out of natural empathy for others, she begins using empathy for herself as a resource. When all empathy is depleted, the nurse is in danger of failing to care not only for others but also for herself.
Conservation of resources theory is actively used in developing frameworks for managing nurse burnout. Van Woerkom, Bakker, and Nishii (2016) have developed a framework for fine-tuning job demands utilizing COR. According to van Woerkom et al. (2016), rational distribution and organizational support help replenish physical and spiritual resources, thus effectively reducing burnout.
Defining Attributes of Nurse Burnout
The three defining attributes of nurse burnout, as defined by Dall’ora et al. (2015), are as follow:
- Decreased working capability. In all cases of nurse burnout, it was followed by a reduction in the quality and quantity of services provided to the patients.
- Depleted emotional state. One of the attributes of burnout in nurses is the inability to feel compassion and empathy for others and for oneself. Since empathy, under the conservation of resources theory, is considered a resource, once it is depleted, it leads to a depressed emotional state that affects the quality of care.
- Physical exhaustion. In many cases of nurse burnout, as evidenced by Dall’ora et al. (2015), physical exhaustion is directly related to nursing burnout.
Antecedents and Consequences
One of the antecedents of nurse burnout comes in the form of increased workload. According to van Woerkom et al. (2016), all work and resource spending must be balanced in order to avoid burnout. Nursing work is associated with long shifts, increased physical, emotional, and mental stress, and frequent overtime. Exposure to increased workload on a daily basis leads to nurse burnout.
The consequences of nurse burnout are many. One of the major consequences that affect healthcare systems worldwide is increased turnover rates. Upon suffering burnout, nurses find themselves at a limit and cannot function as healthcare practitioners to their full capacity. The connection between conservation of resources and turnover rates are obvious – nurses leave jobs that cause burnout, which is an undesired emotional and physical state that results from poor personal resource management (Prapanjaroensin et al. 2017).
The two empirical references that indicate the presence of nurse burnout used in research typically are turnover rates and low indexes of job satisfaction. Dall’ora et al. (2015) use these two references and correlate them to high turnover rates. And it is true, as evidenced in nearly every study presented in this paper, high turnover rates and low job dissatisfaction are caused by nurse burnout. Three defining attributes of burnout, such as decreased working capability, emotional drain, and physical exhaustion, make a nurse feel dissatisfied with her job. Turnover rates and JS indexes are quantifiable references that can be used in empirical research.
Brooke is a nurse that has been working at Jackson Memorial Hospital for 3 years now. The hospital suffers shortages in nursing personnel. As a result of being overworked, Brooke has disrupted sleeping patterns and is always found tired at the workplace. Her attention span is poor, and she sometimes mixes things up while on duty. She exhausts herself quickly and feels sorry for herself rather than for the patients. This case scenario has three attributes that clearly define that Brooke is suffering from nurse burnout.
George is a nurse working at Miami University Hospital after graduating 5 years ago. He is used to working long shifts. He is also a very compassionate person, who sympathizes with his patients even when it is hard for him to do so. However, the amount of work he has to do every day makes him physically incapable of performing his duties at the highest level. After a while, George stopped striving to outdo himself and knowingly set the bar for his quality and quantity of care lower, since he knows he would not be able to help everyone out anyway. This case is a borderline scenario, as not all attributes of burnout are present. As it stands, George is at the early stages of burnout, which is often characterized by 1 or 2 attributes present.
Friedrich the III is a nurse fresh out of college and working at Beaumont Hospital. This is one of the best hospitals in the USA with an excellent working ethic and low turnover rates. The hours are manageable, as Friedrich is considered an intern and is not given full hours. He is eager to prove his commitment and wants to learn from the best. He is genuinely concerned about patient health and safety and wants to do his best to help them recover. In this case scenario, Friedrich the III is not affected by burnout, as he lacks any of the mentioned attributes that define the concept.
Theoretical Applications of the Concept
As stated by Prapanjaroensin et al. (2017), there is a distinct relationship between the theory of resources conservation and nurse burnout. Many researchers view burnout as an effect of a nurse spending more physical, mental, and emotional resources than she is capable of, with the resulting condition diminishing the quality of her work. COR is useful at explaining concepts like nurse burnout, as it is a stress-related physical and psychological condition. Modern strategies develop to reduce its effects on the nursing populace are aimed at more rational usage and conservation of personal resources. The purpose of the concept analysis within the chosen theory is to give a basis for comparison as well as a list of potential solutions available within the scope of its framework.
Nurse burnout is a concept that is associated with lowered productivity, emotional stress, and reduced physical capabilities in nurses as a result of prolonged exposure to conditions that demand the increased use of personal resources. This concept is described within the scope of conservation of resources theory, which puts an emphasis on stress factors developing from the exhaustion of one or more personal resources available to the nurse. The findings presented in this concept analysis can be used in order to develop personalized burnout coping programs that may lead to more efficient schedules and balanced workloads.
While conducting this research, I learned that while nurse burnout is both a physical and a psychological issue, effective strategies aim at removing the causes of personal resource depletion rather than dealing with the psychological issues stemming from it.
Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). New York, NY: Elsevier.
Dall’ora, C., Griffiths, P., & Ball, J. (2015). 12-hour shifts: Nurse burnout, job satisfaction, & intention to leave. CLAHRC Wessex, 3, 1-2.
Hunt, P. A, Denieffe, S., & Gooney, M. (2017). Burnout and its relationship to empathy in nursing: A review of the literature. Journal of Research in Nursing, 22(1), 7-22.
Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work-related stress, burnout, job satisfaction, and general health of nurses. International Journal of Environment Research and Public Nursing, 12(1), 652-666.
Prapanjaroensin, A., Patrician, P. A., & Vance, D. E. (2017). Conservation of resource burnout and nation safety. Journal of Advanced Nursing, 73(11), 2558-2565.
van Woerkom, M., Bakker, A. B., & Nishii, L. H. (2016). Accumulative job demands and support for strength use: Fine-tuning the job demands-resources model using conservation of resources theory. Journal of Applied Psychology, 101(1), 141-150.