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A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia

Published online by Cambridge University Press:  13 November 2018

Harry Costello ,
Sebastian Walsh ,
Claudia Cooper  and
Gill Livingston
Harry Costello*
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Sebastian Walsh
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Claudia Cooper
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Gill Livingston
Affiliation:
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
*
Correspondence should be addressed to: Harry Costello, Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, 149 Tottenham Court Road, W1T 7NF London, UK. Email: [email protected].
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Abstract

Background:

Care home staff stress and burnout may be related to high turnover and associated with poorer quality care. We systematically reviewed and meta-analyzed studies reporting stress and burnout and associated factors in staff for people living with dementia in long-term care.

Methods:

We searched MEDLINE, PsycINFO, Web of Science databases, and CINAHL database from January 2009 to August 2017. Two raters independently rated study validity using standardized criteria. We meta-analyzed burnout scores across comparable studies using a random effects model.

Results:

17/2854 identified studies met inclusion criteria. Eight of the nine studies reporting mean Maslach Burnout Inventory (MBI) scores found low or moderate burnout levels. Meta-analysis of four studies using the 22-item MBI (n = 598) found moderate emotional exhaustion levels (mean 18.34, 95% Confidence Intervals 14.59–22.10), low depersonalization (6.29, 2.39–10.19), and moderate personal accomplishment (33.29, 20.13–46.46). All three studies examining mental health-related quality of life reported lower levels in carer age and sex matched populations. Staff factors associated with higher burnout and stress included: lower job satisfaction, lower perceived adequacy of staffing levels, poor care home environment, feeling unsupported, rating home leadership as poor and caring for residents exhibiting agitated behavior. There was preliminary evidence that speaking English as a first language and working shifts were associated with lower burnout levels.

Conclusions:

Most care staff for long-term care residents with dementia experience low or moderate burnout levels. Prospective studies of care staff burnout and stress are required to clarify its relationship to staff turnover and potentially modifiable risk factors.

Keywords

CarersBurnoutDementiaLong-Term CareNursing homes
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 8: Issue Theme: Dementia Care , August 2019 , pp. 1203 - 1216
Copyright
© International Psychogeriatric Association 2018 

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References

Agoub, M., Elyazaji, M. and Battas, O. (2000). Professional burn out and sources of stress among health care workers. Annales Medico-Psychologiques, 158, 687–692.Google Scholar
Aguayo, R., et al. (2011). A meta-analytic reliability generalization study of the Maslach Burnout inventory. Journal of Clinical and Health Psychology, 11, 343–361.Google Scholar
Barbosa, A., et al. (2015). Supporting direct care workers in dementia care: effects of a psychoeducational intervention. American Journal of Alzheimers Disease and Other Dementias, 30, 130–138. doi: 10.1177/1533317514550331.CrossRefGoogle ScholarPubMed
Boyle, M. H. (1998). Guidelines for evaluating prevalence studies. Evidence Based Mental Health, 1, 37–39. doi: 10.1136/ebmh.1.2.37.CrossRefGoogle Scholar
Castle, N. G. and Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43, 616–626. doi: 10.1097/01.mlr.0000163661.67170.b9.CrossRefGoogle ScholarPubMed
Chamberlain, S. A., et al. (2017). Influence of organizational context on nursing home staff burnout: a cross-sectional survey of care aides in Western Canada. International Journal of Nursing Studies, 71, 60–69. doi: 10.1016/j.ijnurstu.2017.02.024.CrossRefGoogle ScholarPubMed
Chiu, Y. L., Chung, R. G.,Wu, C. S. and Ho, C. H. (2009). The effects of job demands, control, and social support on hospital clinical nurses’ intention to turn over. Applied Nursing Research, 22, 258–263. doi: 10.1016/j.apnr.2008.02.006.CrossRefGoogle ScholarPubMed
de Rooij, A. H. P. M., Luijkx, K. G., Declercq, A. G., Emmerink, P. M. J. and Schols, J. M. G. A. (2012). Professional caregivers’ mental health problems and burnout in small-scale and traditional long term care settings for elderly people with dementia in the Netherlands and Belgium. Journal of the American Medical Directors Association, 13, 486.e7–486.e11. doi: 10.1016/j.jamda.2012.01.001.CrossRefGoogle ScholarPubMed
Duffy, B., Oyebode, J. R. and Allen, J. (2009). Burnout among care staff for older adults with dementia: the role of reciprocity, self-efficacy and organizational factors. Dementia: The International Journal of Social Research and Practice, 8, 515–541. doi: 10.1177/1471301209350285.CrossRefGoogle Scholar
Edvardsson, D., Sandman, P. and Borell, L. (2014). Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26, 1171–1179. doi: 10.1017/S1041610214000258.CrossRefGoogle ScholarPubMed
Edvardsson, D., Sandman, P. O., Nay, R. and Karlsson, S. (2009). Predictors of job strain in residential dementia care nursing staff. Journal of Nursing Management, 17, 59–65. doi: 10.1111/j.1365-2834.2008.00891.x.CrossRefGoogle ScholarPubMed
Fjelltun, A. M., Henriksen, N., Norberg, A., Gilje, F. and Normann, H. K. (2009). Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study. Scandinavian Journal of Caring Sciences, 23, 736–747. doi: 10.1111/j.1471-6712.2008.00672.x.CrossRefGoogle ScholarPubMed
Furumura, M. and Ishitake, T. (2014). The relationship between burnout, personal traits, and the work environment of caregivers in group homes. Nippon Koshu Eisei Zasshi - Japanese Journal of Public Health, 59, 822–832. doi: 10.11236/jph.59.11_822.Google Scholar
Gao, F. S., Newcombe, P., Tilse, C., Wilson, J. and Tuckett, A. (2014). Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data. International Journal of Nursing Studies, 51, 1258–1270. doi: 10.1016/j.ijnurstu.2014.01.011.CrossRefGoogle ScholarPubMed
Harvey, S. B., et al. (2018) The role of job strain in understanding midlife common mental disorder: a national birth cohort study. The Lancet Psychiatry, 5, 498–506. doi: 10.1016/S2215-0366(18)30137-8.CrossRefGoogle ScholarPubMed
Health Education England (2014). Growing Nursing Numbers Literature on nurses leaving the NHS. Available from https://hee.nhs.uk/sites/default/files/documents/Nurses%20leaving%20practice%20-%20Literature%20Review.pdf. Accessed 4 April 2018.Google Scholar
House of Commons Committee of Public Accounts (2008). Improving services and support for people with dementia. Sixth report of session 2007–2008. London: Stationary Office.Google Scholar
Ikegami, N. and Campbell, J. C. (1995). Medical-care in Japan. New England Journal of Medicine, 333, 1295–1299. doi: 10.1056/NEJM199511093331922.CrossRefGoogle Scholar
Islam, M. S., Baker, C., Huxley, P., Russell, I. T. and Dennis, M. S. (2017) The nature, characteristics and associations of care home staff stress and wellbeing: a national survey. BMC Nursing, 16, 22. doi: 10.1186/s12912-017-0216-4.CrossRefGoogle ScholarPubMed
Juthberg, C., Eriksson, S., Norberg, A. and Sundin, K. (2010). Perceptions of conscience, stress of conscience and burnout among nursing staff in residential elder care. Journal of Advanced Nursing, 66, 1708–1718. doi: 10.1111/j.1365-2648.2010.05288.x.CrossRefGoogle ScholarPubMed
Lake, E. T. (2007). The nursing practice environment—measurement and evidence. Medical Care Research and Review, 64, 104s–122s. doi: 10.1177/1077558707299253.CrossRefGoogle ScholarPubMed
Larrabee, J. H., et al. (2010). Influence of stress resiliency on RN job satisfaction and intent to stay. Western Journal of Nursing Research, 32, 81–102. doi: 10.1177/0193945909343293.CrossRefGoogle ScholarPubMed
Livingston, G., Barber, J. and Marston, L. (2017). Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study. BJPsych Open, 3, 171–178. doi: 10.1192/bjpo.bp.117.005181.CrossRefGoogle ScholarPubMed
Lucchetti, G., et al. (2014). Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers. Journal of Psychiatric and Mental Health Nursing, 21, 403–413. doi: 10.1111/jpm.12092.CrossRefGoogle ScholarPubMed
Luppa, M., et al. (2010). Prediction of institutionalization in the elderly. A systematic review. Age and Ageing, 39, 31–38. doi: 10.1093/ageing/afp202.CrossRefGoogle ScholarPubMed
Maslach, C. and Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behaviour, 2, 99–113. doi: 10.1002/job.4030020205.CrossRefGoogle Scholar
Maslach, C., et al. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. doi: 10.1146/annurev.psych.52.1.397.CrossRefGoogle ScholarPubMed
Malach-Pines, A. (2008). Stress and burnout: the significant difference. Journal of Pediatric Hematology Oncology, 30, 109–109.Google Scholar
McManus, I. C., Winder, B. C. and Gordon, D. (2002). The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet, 359, 2089–2090. doi: 10.1016/S0140-6736(02)08915-8.CrossRefGoogle Scholar
Pejtersen, J. H., Kristensen, T. S., Borg, V. and Bjorner, J. B. (2010). The second version of the Copenhagen psychosocial questionnaire. Scandinavian Journal of Public Health, 38, 8–24. doi: 10.1177/1403494809349858.CrossRefGoogle ScholarPubMed
Pines, A. M. (2002). A psychoanalytic-existential approach to burnout: demonstrated in the cases of a nurse, a teacher, and a manager. Psychotherapy, 39, 103–113. doi: 10.1037/0033-3204.39.1.103.CrossRefGoogle Scholar
Pitfield, C., Shahriyarmolki, K. and Livingston, G. (2011). A systematic review of stress in staff caring for people with dementia living in 24-hour care settings. International Psychogeriatrics, 23, 4–9. doi: 10.1017/S1041610210000542.CrossRefGoogle ScholarPubMed
Ribbe, M. W., et al. (1997). Nursing homes in 10 nations: a comparison between countries and settings. Age and Ageing, 26, 3–12. doi: 10.1093/ageing/26.suppl_2.3.CrossRefGoogle ScholarPubMed
Schaefer, J. A. and Moos, R. H. (1996). Effects of work stressors and work climate on long-term care staff’s job morale and functioning. Research in Nursing & Health, 19, 63–73. doi: 10.1002/(SICI)1098-240X(199602)19:1<63::AID-NUR7>3.0.CO;2-J.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Schaufeli, W. G. and Vandierendonck, D. (1995). A cautionary note about the cross-national and clinical validity of cutoff points for the Maslach-Burnout-inventory. Psychological Reports, 77, 1083–1090. doi: 10.2466/pr0.1995.76.3c.1083.CrossRefGoogle Scholar
Schmidt, S. G., Dichter, M. N., Bartholomeyczik, S. and Hasselhorn, H. M. (2014). The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes. Geriatric Nursing, 35, 42–46. doi: 10.1016/j.gerinurse.2013.09.006.CrossRefGoogle ScholarPubMed
Schmidt, S. G., Dichter, M. N., Palm, R. and Hasselhorn, H. M. (2012). Distress experienced by nurses in response to the challenging behaviour of residents–evidence from German nursing homes. Journal of Clinical Nursing, 21, 3134–3142. doi: 10.1111/jocn.12066.CrossRefGoogle ScholarPubMed
Tanaka, K., et al. (2015). Burnout of long-term care facility employees: relationship with employees’ expressed emotion toward patients. International Journal of Gerontology, 9, 161–165. doi: 10.1016/j.ijge.2015.04.001.CrossRefGoogle Scholar
Testad, I., Mikkelsen, A., Ballard, C. and Aarsland, D. (2010). Health and well-being in care staff and their relations to organizational and psychosocial factors, care staff and resident factors in nursing homes. International Journal of Geriatric Psychiatry, 25, 789–797. doi: 10.1002/gps.2419.CrossRefGoogle ScholarPubMed
Vogel, B., De Geest, S., Fierz, K., Beckmann, S. and Zuniga, F. (2017). Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP). International Psychogeriatrics, 29, 441–454. doi: 10.1017/S1041610216002027.CrossRefGoogle Scholar
VonDras, D. D., Flittner, D. Malcore, S. A. and Pouliot, G. (2009). Workplace stress and ethical challenges experienced by nursing staff in a nursing home. Educational Gerontology, 35, 323–341. doi: 10.1080/03601270802605382.CrossRefGoogle Scholar
Willemse, B. M., de Jonge, J.Smit, D. Depla, M. F. I. A. and Pot, A. M. (2012). The moderating role of decision authority and coworker- and supervisor support on the impact of job demands in nursing homes: a cross-sectional study. International Journal of Nursing Studies, 49, 822–833. doi: 10.1016/j.ijnurstu.2012.02.003.CrossRefGoogle ScholarPubMed
Willemse, B. M., et al. (2015). Staff’s person-centredness in dementia care in relation to job characteristics and job-related well-being: a cross-sectional survey in nursing homes. Journal of Advanced Nursing, 71, 404–416. doi: 10.1111/jan.12505.CrossRefGoogle ScholarPubMed
Woodhead, E. L., Northrop, L. and Edelstein, B. (2016). Stress, social support, and burnout among long-term care nursing staff. Journal of Applied Gerontology, 35, 84–105. doi: 10.1177/0733464814542465.CrossRefGoogle ScholarPubMed
Yada, H., et al. (2014). Job-related stress in psychiatric nurses in Japan caring for elderly patients with dementia. Environmental Health and Preventive Medicine, 19, 436–443. doi: 10.1007/s12199-014-0414-6.CrossRefGoogle ScholarPubMed
Zimmerman, S., et al. (2005). Attitudes, stress, and satisfaction of staff who care for residents with dementia. Gerontologist, 45, 96–105. doi: 10.1093/geront/45.suppl_1.96.CrossRefGoogle ScholarPubMed