Review of Literature Draft_

STRESS AND BURNOUT IN HEALTHCARE WORKERS 1 Stress and Burnout in Healthcare Workers Paula M. Hoewischer University of the Incarnate Word ORGD 6330 Foundations of Organizational Research and Assessment Dr. Noah Kasraie

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 Abstract COVID-19 was the prime leading cause of stress and burnout in healthcare workers. There were many uncertainties about its signs and symptoms during its early stages of emergence. Nurses, for example, were exhausted physically and mentally due to having to make difficult decisions and grieving the loss of patients and colleagues. They were also at risk of contracting infections from patients, making them concerned about infecting their family members. Through intensive interviews, healthcare professionals expressed their feelings about the pandemic. In addition, stress and burnout have led to several deaths and increased hospitalization rates. As a result, healthcare professionals worked under strict time constraints, resulting in limited time with family members. According to a medical report from physical and medical staff, many healthcare workers experienced ethical quandaries and moral injuries during the peak of COVID-19. They also face challenges due to shifting overload, pathogen exposure, and critical changes implemented in healthcare organizations. According to a WHO study on stress and burnout in healthcare workers, most healthcare professionals are at risk of burnout. High-stress environments exacerbate stress and burnout in healthcare professionals. Keywords: Covid-19, WHO, burnout, stress, pathogen

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 contacted were at greater risk, which provided an opportunity to identify research gaps in this field (Costa & Pinto, 2017). Many healthcare workers face difficulties due to shifting overload, pathogen exposure, and essential organizational changes (Yates, 2020). According to a WHO study on stress and burnout in healthcare workers, most healthcare professionals are at risk of burnout. High-stress environments are among the factors that contribute to stress and burnout in healthcare professionals. High-Stress Environment Because of the nature of their health professionals’ responsibilities, most healthcare professionals work in a high-stress environment. According to World Health Organization (WHO), more than 30% of nurses reported emotional torture or emotional exhaustion, resulting in cases of stress and burnout. Some nurses worked in incentive care and emergency departments, which psychologically impacted healthcare professionals (Dinibutun, 2020). Emotional Strain from Patient Care Undoubtedly, another critical factor contributing to stress and burnout in healthcare professionals is the emotional strain from patient care. Healthcare workers are responsible for making patients feel better after treatment, which makes nurses feel better when they are satisfied with seeing all patients improve after treatments. As a result of the ratio, some critical causes of burnout occur (Sharifi et al., 2021). For example, healthcare professionals with a higher patient load have a higher rate of burnout (1:4 nurse-to-patient ratio). Professional healthcare workers face more significant risks in high-stress environments, which leads to burnout and stress. As a result, they develop depressive disorders, which negatively impact their health.

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 According to Cha et al. (2022), the COVID-19 pandemic was a trying time for healthcare workers. Several of them quit their jobs at the time, while others chose to stay. Indeed, burnout can manifest itself in three ways: physically, emotionally, and behaviorally. Physical burnout symptoms include fatigue, low energy, frequent illness, headaches, and muscle pain. As COVID- 19 continued to spread, nurses' shortage emerged because most were quitting their jobs. The remaining caregivers would have to work extra hours to meet patients’ demands. This sapped their energy and caused them physical discomfort. Getting sick frequently was also due to working overtime because a patient infected with the virus could be brought in at any time. Inadequate organizational support also demoralized healthcare workers (Soares et al., 2022). Because the pandemic struck so suddenly, the organization's leaders may need more time or resources to address the issue. Furthermore, the virus was rapidly spreading. In some cases, healthcare workers could not save patients' lives, making them feel hopeless and incompetent because they could not do their job committedly and save lives. Some healthcare workers also developed virus symptoms and were quarantined, putting additional strain on the remaining caregivers and leaving them helpless (La Torre et al., 2022). They also lived in constant fear of becoming infected by the virus. Emotional burnout would also strike them, causing them to feel alone, unmotivated, doubt themselves, and bitter about life. Long working hours have altered their sleeping patterns, resulting in very few hours of sleep, thus causing anxiety and stress and increasing patient care errors (Sevinc et al., 2022). Mercado et al. (2022) contend that the healthcare workers also felt as if they were fighting this battle alone, with no support from family or friends. Due to a lack of emotional support, they began to doubt themselves and their abilities. Lack of communication made it

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 healthcare since it poses adverse consequences to patients and healthcare systems ( Kloutsiniotis et al., 2022). Some of the common healthcare effects of burnout include; absenteeism, reduced quality care, higher workforce turnover, increased medical errors and reduced productivity. The three significant components of burnout include; a diminished sense of personal accomplishment, depersonalization, and emotional exhaustion. During the peak of the pandemic spread, burnout was considered a key occupational risk in healthcare. Some workplace factors that may have contributed to burnout include; a lack of scheduling flexibility, high workload, concern about workplace safety, and the burden of administrative tasks ( Tang & Li, 2021). In addition, some extra sources of burnout have emerged during COVID-19 and they include; redeployment to unfamiliar types of work and constraints on care leading to moral distress. According to the existing research studies, the severity of psychological exhaustion during the global pandemic was higher in nurses than in other healthcare professionals of other disciplines ( Green & Kinchen, 2021). They were followed by nonprofessional staff who have close contact with patients. Nonprofessional staff whose work does not involve close patient contact registered the lowest number. Even before the emergence of COVID-19, many people believed that medical practice was stressful since healthcare professionals must respond to the demanding needs of patients and their families ( Peasley et al., 2020). Nevertheless, medical procedures and knowledge often involve uncertainties and limitations. It is undeniable that any slight medical mistake or error may be irreversible, costly, and harmful to a patient’s life. In addition, shift work, night work, and long work hours are common and obvious in medical professions ( Kobayashi et al., 2020). Many research studies have found that burnout may also be caused by long-term exposure to job- related stress. Initially, Freudenberger defined burnout as the gradual loss of motivation,

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 emotional depletion, and reduced commitment among volunteers working for a drug misuser. It is currently perceived as a psychological syndrome caused by employees' exposure to a stressful working environment with low resources but job demands. Three decades ago, burnout was predominantly reported with jobs linked with human services ( Kloutsiniotis et al., 2022). In the contemporary world, burnout and stress are imperative health issues among healthcare professionals. Notably, burnout is associated with more outstanding suboptimal quality of care and medical errors and endangers healthcare professionals' health and well-being. Purpose of Study The primary purpose of the research study is to investigate how the COVID-19 pandemic caused stress and burnout among healthcare workers. Furthermore, the study will determine the adverse effects of stress and burnout in a healthcare setting. The study will employ qualitative research methodology to collect data and information from the research participants. The participants will be sampled from the Military Treatment Facility and Level 1 Trauma Center and involved through in-depth interviews and questionnaires. Through questionnaires, they will be provided with questions and blank papers, which they are expected to answer based on their perspectives. In addition, five-minute interviews will be conducted on an individual basis. As motivating factors, they will be offered incentives at the end of interviews. Finally, the collected data will be compiled and analyzed using qualitative techniques.

STRESS AND BURNOUT IN HEALTHCARE WORKERS 2 physicians, admin, residents, and technicians participated were sampled to provide their responses based on the questionnaire questions. The research participants were classified based on professional roles, age, gender, and work location. Sample Selection When selecting the study sample, the researcher employed inclusion and exclusion criteria. To be picked to participate in the study, the person had to be directly linked with the research question. As a result, any competent participant from any other profession was allowed to participate in the study. Following that, the researcher restricted himself to participants from the healthcare sector working in Military Treatment Facilities and Level 1 Trauma Centers. As a result, the matching exclusion criterion was that the researcher did not consider a participant who does not work in Military Treatment Facility and Level 1 Trauma Center. Furthermore, the investigator chose only participants who could provide informed information and data. Therefore, participants who voiced reservations about participating in the study were not eligible. The researcher chose only healthcare workers who could interpret the questions, understand them, and provide honest responses. The underlying exclusion criterion was that the inquirer needed to select respondents who showed an apparent lack of understanding of what was happening. To summarize, examining potential volunteers' abilities was a key outcome of the study

STRESS AND BURNOUT IN HEALTHCARE WORKERS 11 Appendix Work Role Physician Nurse Technician Resident Admin 16 47 19 14 4 Work Location Emergency Medicine InPatient Outpatient Ancillary Admin 11 33 26 23 7 Gender Male Female 46 54 Age Range 18-25 26-35 36-45 45-60 Over 60 17 9 43 26 5 Always or to a very high degree Often or to a high degree Sometimes or somewhat Seldom or to a low degree Never or to a very low degree How often were you exhausted physically and/or mentally from working through COVID? 37 23 27 11 2 Have enough energy when spending time with family or friends during your off days? 14 29 31 17 9 Does your work frustrate you? 10 21 43 19 7 Do you feel burnt out (complete physical or mental exhaustion) because of your work? 31 22 18 21 9 You were drained emotionally while working during COVID? 18 32 27 19 4 Felt supported by leadership at all levels of the 10 17 24 20 29

STRESS AND BURNOUT IN HEALTHCARE WORKERS 13 References Cha, Y. J., Lee, K. S., Cho, J. H., Choi, I. S., & Lee, D. (2022). Effect of job stress on burnout among nurses responding to COVID-19: the mediating effect of resilience. International Journal of Environmental Research and Public Health , 19 (9), 5409. Costa, B., & Pinto, I. C. (2017). Stress, burnout and coping in health professionals: A literature review. Journal of Psychology and Brain Studies , 1 (1: 4), 1-8. Dinibutun, S. R. (2020). Factors associated with burnout among physicians: an evaluation during a period of COVID-19 pandemic. Journal of healthcare leadership , 12 , 85. Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in nurses. Journal of Holistic Nursing , 39 (4), 356-368. Hall, H. (2020). The effect of the COVID-19 pandemic on healthcare workers' mental health. Jaapa , 33 (7), 45–48. Kloutsiniotis, P. V., Mihail, D. M., Mylonas, N., & Pateli, A. (2022). Transformational Leadership, HRM practices and burnout during the COVID-19 pandemic: The role of personal stress, anxiety, and workplace loneliness. International Journal of Hospitality Management , 102 , 103177. Kobayashi, Y., Oe, M., Ishida, T., Matsuoka, M., Chiba, H., & Uchimura, N. (2020). Workplace violence and its effects on burnout and secondary traumatic stress among mental healthcare nurses in Japan. International journal of environmental research and public health , 17 (8), 2747. Leitão, J., Pereira, D., & Gonçalves, Â. (2021). Quality of work life and contribution to productivity: Assessing the moderator effects of burnout syndrome. International Journal of Environmental Research and Public Health , 18 (5), 2425.

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