Burnout, Anxiety, and Professional Self-Concept in Nurses During the COVID-19 Pandemic in Iran
-
Alia Saberi
,
Sajjad Saadat
,
Ali Pourramazani
,
Fateme Eftekhari
,
Hamidreza Hatamian
,
Marjan Entezari
Abstract
The aim of this study was to evaluate the burnout, anxiety, and professional self-concept of nurses according to their demographic and occupational information. 160 nurses from Razi and Poursina hospitals in Iran were selected as a sample in this cross-sectional online survey and answered the tools Demographic and Occupational Information Questionnaire (DOIQ), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Corona Disease Anxiety Scale (CDAS) and Nurse Self-Concept Questionnaire (NSCQ). Data analysis was performed in two descriptive and inferential sections using SPSS-19 statistics software. The participation rate in this study was 87.5% (n=140). The mean age was 32.56 (SD=7.26) years. The burnout rate in emotional exhaustion (EE) was 24.3%, depersonalization (DP) was 32.1%, and personal accomplishment (PA) was 60.7%, 21.4% of nurses had high anxiety, and 53.6% had low NSCQ. EE score was higher in nurses with less than ten years of experience (t=2.21) and single people (t=-3.18). DP score was higher in people under 35 years (t=3.20), with work experience of fewer than ten years (t=4.34), and single people (t=-3.07). Females in PA reported more burnout (t=-2.43). CDAS score was higher in females (t=3.20). NSCQ score was higher in married people (t=-3.07). CDAS was positively correlated with EE and DP and negatively correlated with PA. NSCQ was negatively correlated with EE and DP and positively correlated with PA. At first, a high CDAS score and then celibacy, less than ten years of work experience, and a low NSCQ score were effective in multiple linear regression analysis for MBI-HSS.
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3. Alizadeh A, Khankeh HR, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian healthcare
providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study. BMC Psychiatry 2020;20:494.
4. Jackson D, Anders R, Padula WV, Daly J, Davidson PM.Vulnerability of nurse and physicians with COVID-19:
monitoring and surveillance needed. J Clin Nurs 2020;29:3584-7.
5. Karimi Z, Fereidouni Z, Behnammoghadam M, et al. The lived experience of nurses caring for patients with COVID-
19 in Iran: a phenomenological study. Risk Manag Healthc Policy 2020;13:1271-8.
6. Jalili M, Niroomand M, Hadavand F, Zeinali K, Fotouhi A.Burnout among healthcare professionals during COVID-
19 pandemic: a cross-sectional study. Int Arch OccupEnviron Health 2021;94:1345-52.
7. Hoseinabadi TS, Kakhki S, Teimori G, Nayyeri S. Burnoutand its influencing factors between frontline nurses and
nurses from other wards during the outbreak ofCoronavirus Disease-COVID-19-in Iran. Invest Educ
Enferm 2020;38:e3.
8. Kamali M, Sadati AK, Khademi MR, Ghahramani S, Zarei L, Ghaemi SZ, et al. Burnout among Nurses during
Coronavirus Disease 2019 Outbreak in Shiraz. Galen MedJ 2020;9:e1956.
9. Soto-Rubio A, Giménez-Espert MD, Prado-Gascó V.Effect of emotional intelligence and psychosocial risks on
burnout, job satisfaction, and nurses' health during thecovid-19 pandemic. Int J Environ Res Public Health
2020;17:7998.
10. Aziziaram S, Basharpoor S. The Role of Rumination,Emotion Regulation and Responsiveness to Stress in
Predicting of Corona Anxiety (COVID-19) among Nurses.QJNM 2020;9:8-18.
11. Asadi N, Salmani F, Pourkhajooyi S, Mahdavifar M,Royani Z, Salmani M. Investigating the RelationshipBetween Corona Anxiety and Nursing Care BehaviorsWorking in Corona's Referral Hospitals. IJPCP2020;26:306-19.
12. Pappa S, Athanasiou N, Sakkas N, Patrinos S, Sakka E,Barmparessou Z, et al. From recession to depression?
prevalence and correlates of depression, anxiety, traumatic stress and burnout in healthcare workers during the
COVID-19 pandemic in Greece: A multi-center, crosssectionalstudy. Int J Environ Res Public Health
2021;18:2390.
13. Cocchiara RA, Peruzzo M, Mannocci A, Ottolenghi L, Villari P, Polimeni A, et al. The use of yoga to manage
stress and burnout in healthcare workers: A systematic review. J Clin Med 2019;8:284.
14. Kelly S, Courts N. The professional self-concept of new graduate nurses. Nurse Educ Pract 2007;7:332-7.
15. Lee EM, Kim DH. Moderating effects of professional selfconcept in relationship between workplace bullying and
nursing service quality among hospital nurses. J Korean Acad Nurs Adm 2018;24:375-86.
16. Cao X, Chen L, Tian L, Diao Y. The effect of perceived organisational support on burnout among community
health nurses in China: the mediating role of professional self‐ concept. J Nurs Manag 2016;24:77-86.
17. Yeom EY, Jeon HO. Relations of burnout, interpersonal relations, professional self-concept and depression in
clinical nurses. J Korea Aca-Indus coop Soci 2013;14:2869-79.
18. Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of
healthcare in terms of safety and acceptability: a systematic review. BMJ Open 2017;7:e015141.
19. Maslach C. Burnout: The Cost of Caring. Cambridge, MA:Malor Books, 2003.
20. Moalemi S, Kavoosi Z, Beygi N, Deghan A, Karimi A, Parvizi MM. Evaluation of the Persian Version of Maslach
Burnout Inventory-Human Services Survey among Iranian Nurses: Validity and Reliability. Galen Med J
2018;7:e995.
21. Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. Preliminary validation of the Corona Disease Anxiety
Scale (CDAS) in the Iranian sample. QJHP 2020;8:163-75.
22. Heydari A, Shokouhi Targhi E. The effect of an educational-orientation program upon professional self of undergraduate nursing students. Iran J Med Educ 2014;14:438-94.
23. Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting
of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014;12:1500-24.
24. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear
statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional
study. EClinicalMedicine 2020;24:100424.
25. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. JAMA 2002;288:1987-93.
26. Kalateh Sadati A, Zarei L, Shahabi S, Heydari ST, Taheri V, Jiriaei R, et al. Nursing experiences of COVID‐ 19
outbreak in Iran: A qualitative study. Nurs Open 2021;8:72-9.
27. Kim WK, Chung KH. The relationship between professional self-concept, organizational commitment and
job satisfaction in clinical nurses. J Korean Acad Nursing Adm 2008;14:287-96.
28. Cao X, Chen L, Tian L, Diao Y, Hu X. Effect of professional self‐ concept on burnout among community
health nurses in C hengdu, C hina: the mediator role of organisational commitment. J Clin Nurs 2015;24:2907-15.
29. Yu J, Lee S, Kim M, Lim K, Chang K, Chae S. Professional self-concept and burnout among medical
school faculty in South Korea: a cross-sectional study. BMC Med Educ 2019;19:1-6.
30. Dimunová L, Nagyová I. The relationship between burnout and the length of work experience in nurses and midwives in the Slovak Republic. Profese Online 2012;5:1-4.
31. Ravari A, Sayadi A, Khodadadi H, Jafarinaveh H. Occupational burnout assessment among nurses working
in Iranian hospital of Ali-ebn Abitaleb, Rafsanjan-Iran. J Occup Health Epidemiol 2012;1:103-10.
32. Mudallal RH, Othman WA, Al Hassan NF. Nurses' burnout: the influence of leader empowering behaviors,
work conditions, and demographic traits. Inquiry 2017;54:1-10.
33. Ortega E, Ramirez-Baena L, la Fuente-Solana D, Emilia I, Vargas C, Gómez-Urquiza JL. Gender, marital status, and
children as risk factors for burnout in nurses: A metaanalytic study. Int J Environ Res Public Health 2018;15:2102.
34. Li L, Ruan H, Yuan WJ. The relationship between social support and burnout among ICU nurses in Shanghai: A
cross-sectional study. Chin Nurs Res 2015;2:45-50.
35. Orsal O, Orsal O, Duru P, Unsal A, Barlas N. Evaluation of the factors associated with Burnout of nurses working at
a state hospital in turkey. Nurs Pract Today 2017;4:21-34.
36. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, et al. A large‐ scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID‐ 19 pandemic. Int J Ment Health Nurs 2021;30:102-16.
37. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. Journal Vocat Behav 2010;77:168-85.
38. Savitsky B, Findling Y, Ereli A, Hendel T. Anxiety and coping strategies among nursing students during the covid-
19 pandemic. Nurse Educ Pract 2020;46:102809.
39. Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and selfefficacy among nurses during COVID‐ 19 pandemic: A large cross‐ sectional study. J Clin Nurs 2021;30:1360-71.
40. Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: predictive role of organisational
support, personal resilience and social support. J Nurs Manag 2020;28:1653-61.
41. Mo Y, Deng L, Zhang L, Lang Q, Pang H, Liao C, et al. Anxiety of Nurses to support Wuhan in fighting against
COVID‐ 19 Epidemic and its Correlation with Work Stress and Self‐ efficacy. J Clin Nurs 2021;30:397-405.
42. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci
2015;17:327.
43. Arthur D, Sohng KY, Noh CH, Kim S. The professional self-concept of Korean hospital nurses. Int J Nurs Stud
1998;35:155-62.
44. Piatkowski SL. An exploration of self-concept and life satisfaction of single women [dissertations]. Michigan,
United States:Ypsilanti: Eastern Michigan University,2012.
2019 novel coronavirus (2019-nCoV) infected pneumonia(standard version). Mil Med Res 2020;7:4.
2. Khademian F, Delavari S, Koohjani Z, Khademian Z. An investigation of depression, anxiety, and stress and its
relating factors during COVID-19 pandemic in Iran. BMCPublic Health 2021;21:1-7.
3. Alizadeh A, Khankeh HR, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian healthcare
providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study. BMC Psychiatry 2020;20:494.
4. Jackson D, Anders R, Padula WV, Daly J, Davidson PM.Vulnerability of nurse and physicians with COVID-19:
monitoring and surveillance needed. J Clin Nurs 2020;29:3584-7.
5. Karimi Z, Fereidouni Z, Behnammoghadam M, et al. The lived experience of nurses caring for patients with COVID-
19 in Iran: a phenomenological study. Risk Manag Healthc Policy 2020;13:1271-8.
6. Jalili M, Niroomand M, Hadavand F, Zeinali K, Fotouhi A.Burnout among healthcare professionals during COVID-
19 pandemic: a cross-sectional study. Int Arch OccupEnviron Health 2021;94:1345-52.
7. Hoseinabadi TS, Kakhki S, Teimori G, Nayyeri S. Burnoutand its influencing factors between frontline nurses and
nurses from other wards during the outbreak ofCoronavirus Disease-COVID-19-in Iran. Invest Educ
Enferm 2020;38:e3.
8. Kamali M, Sadati AK, Khademi MR, Ghahramani S, Zarei L, Ghaemi SZ, et al. Burnout among Nurses during
Coronavirus Disease 2019 Outbreak in Shiraz. Galen MedJ 2020;9:e1956.
9. Soto-Rubio A, Giménez-Espert MD, Prado-Gascó V.Effect of emotional intelligence and psychosocial risks on
burnout, job satisfaction, and nurses' health during thecovid-19 pandemic. Int J Environ Res Public Health
2020;17:7998.
10. Aziziaram S, Basharpoor S. The Role of Rumination,Emotion Regulation and Responsiveness to Stress in
Predicting of Corona Anxiety (COVID-19) among Nurses.QJNM 2020;9:8-18.
11. Asadi N, Salmani F, Pourkhajooyi S, Mahdavifar M,Royani Z, Salmani M. Investigating the RelationshipBetween Corona Anxiety and Nursing Care BehaviorsWorking in Corona's Referral Hospitals. IJPCP2020;26:306-19.
12. Pappa S, Athanasiou N, Sakkas N, Patrinos S, Sakka E,Barmparessou Z, et al. From recession to depression?
prevalence and correlates of depression, anxiety, traumatic stress and burnout in healthcare workers during the
COVID-19 pandemic in Greece: A multi-center, crosssectionalstudy. Int J Environ Res Public Health
2021;18:2390.
13. Cocchiara RA, Peruzzo M, Mannocci A, Ottolenghi L, Villari P, Polimeni A, et al. The use of yoga to manage
stress and burnout in healthcare workers: A systematic review. J Clin Med 2019;8:284.
14. Kelly S, Courts N. The professional self-concept of new graduate nurses. Nurse Educ Pract 2007;7:332-7.
15. Lee EM, Kim DH. Moderating effects of professional selfconcept in relationship between workplace bullying and
nursing service quality among hospital nurses. J Korean Acad Nurs Adm 2018;24:375-86.
16. Cao X, Chen L, Tian L, Diao Y. The effect of perceived organisational support on burnout among community
health nurses in China: the mediating role of professional self‐ concept. J Nurs Manag 2016;24:77-86.
17. Yeom EY, Jeon HO. Relations of burnout, interpersonal relations, professional self-concept and depression in
clinical nurses. J Korea Aca-Indus coop Soci 2013;14:2869-79.
18. Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of
healthcare in terms of safety and acceptability: a systematic review. BMJ Open 2017;7:e015141.
19. Maslach C. Burnout: The Cost of Caring. Cambridge, MA:Malor Books, 2003.
20. Moalemi S, Kavoosi Z, Beygi N, Deghan A, Karimi A, Parvizi MM. Evaluation of the Persian Version of Maslach
Burnout Inventory-Human Services Survey among Iranian Nurses: Validity and Reliability. Galen Med J
2018;7:e995.
21. Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. Preliminary validation of the Corona Disease Anxiety
Scale (CDAS) in the Iranian sample. QJHP 2020;8:163-75.
22. Heydari A, Shokouhi Targhi E. The effect of an educational-orientation program upon professional self of undergraduate nursing students. Iran J Med Educ 2014;14:438-94.
23. Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting
of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014;12:1500-24.
24. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear
statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional
study. EClinicalMedicine 2020;24:100424.
25. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. JAMA 2002;288:1987-93.
26. Kalateh Sadati A, Zarei L, Shahabi S, Heydari ST, Taheri V, Jiriaei R, et al. Nursing experiences of COVID‐ 19
outbreak in Iran: A qualitative study. Nurs Open 2021;8:72-9.
27. Kim WK, Chung KH. The relationship between professional self-concept, organizational commitment and
job satisfaction in clinical nurses. J Korean Acad Nursing Adm 2008;14:287-96.
28. Cao X, Chen L, Tian L, Diao Y, Hu X. Effect of professional self‐ concept on burnout among community
health nurses in C hengdu, C hina: the mediator role of organisational commitment. J Clin Nurs 2015;24:2907-15.
29. Yu J, Lee S, Kim M, Lim K, Chang K, Chae S. Professional self-concept and burnout among medical
school faculty in South Korea: a cross-sectional study. BMC Med Educ 2019;19:1-6.
30. Dimunová L, Nagyová I. The relationship between burnout and the length of work experience in nurses and midwives in the Slovak Republic. Profese Online 2012;5:1-4.
31. Ravari A, Sayadi A, Khodadadi H, Jafarinaveh H. Occupational burnout assessment among nurses working
in Iranian hospital of Ali-ebn Abitaleb, Rafsanjan-Iran. J Occup Health Epidemiol 2012;1:103-10.
32. Mudallal RH, Othman WA, Al Hassan NF. Nurses' burnout: the influence of leader empowering behaviors,
work conditions, and demographic traits. Inquiry 2017;54:1-10.
33. Ortega E, Ramirez-Baena L, la Fuente-Solana D, Emilia I, Vargas C, Gómez-Urquiza JL. Gender, marital status, and
children as risk factors for burnout in nurses: A metaanalytic study. Int J Environ Res Public Health 2018;15:2102.
34. Li L, Ruan H, Yuan WJ. The relationship between social support and burnout among ICU nurses in Shanghai: A
cross-sectional study. Chin Nurs Res 2015;2:45-50.
35. Orsal O, Orsal O, Duru P, Unsal A, Barlas N. Evaluation of the factors associated with Burnout of nurses working at
a state hospital in turkey. Nurs Pract Today 2017;4:21-34.
36. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, et al. A large‐ scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID‐ 19 pandemic. Int J Ment Health Nurs 2021;30:102-16.
37. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. Journal Vocat Behav 2010;77:168-85.
38. Savitsky B, Findling Y, Ereli A, Hendel T. Anxiety and coping strategies among nursing students during the covid-
19 pandemic. Nurse Educ Pract 2020;46:102809.
39. Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and selfefficacy among nurses during COVID‐ 19 pandemic: A large cross‐ sectional study. J Clin Nurs 2021;30:1360-71.
40. Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: predictive role of organisational
support, personal resilience and social support. J Nurs Manag 2020;28:1653-61.
41. Mo Y, Deng L, Zhang L, Lang Q, Pang H, Liao C, et al. Anxiety of Nurses to support Wuhan in fighting against
COVID‐ 19 Epidemic and its Correlation with Work Stress and Self‐ efficacy. J Clin Nurs 2021;30:397-405.
42. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci
2015;17:327.
43. Arthur D, Sohng KY, Noh CH, Kim S. The professional self-concept of Korean hospital nurses. Int J Nurs Stud
1998;35:155-62.
44. Piatkowski SL. An exploration of self-concept and life satisfaction of single women [dissertations]. Michigan,
United States:Ypsilanti: Eastern Michigan University,2012.
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| Issue | Vol 60 No 9 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i9.11099 | |
| Keywords | ||
| Coronavirus disease 2019 (COVID-19) Anxiety Nurses Burnout Self-concept | ||
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How to Cite
1.
Saberi A, Saadat S, Pourramazani A, Eftekhari F, Hatamian H, Entezari M. Burnout, Anxiety, and Professional Self-Concept in Nurses During the COVID-19 Pandemic in Iran. Acta Med Iran. 2022;60(9):575-582.
