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might leave other people unaffected. This is the true challenge of burnout; to find a solution which would be universal or universal enough to work for a majority of people. Two important findings in this study which might serve as suggestions for prevention are social support and psychological immunity. Both of these variables came out with separate and interesting findings and they will be discussed in light of prevention of burnout. This study found that both the Hungarian and Swedish nurses reported to receive high levels of social support. It was also found that social support could not be related to burnout in this study, however since the nurses reported high levels of social support it might give an indication of an area worth while focusing on. Researchers have shown the importance of social support in prevention of burnout (see for example Garrett & McDaniel, 2001; Maslach et al., 2001) and thus it may be an important area to look further into. Since both of the samples in this study reported high levels of social support, further studies could focus on how to attain high social support. Looking at groups which already report to have high social support, can assist in revealing the reasons behind it and researchers can look into how to help nurses (and other professions) in attaining it, for example which factors are more precisely promoting social support. If these factors could be identified then the next step would be to introduce these variables for people and in places where social support has been shown to be low and where burnout has been shown to be high. Then steps could be taken to promote social support among people and in workplaces in order to promote lower levels of burnout or to even prevent burnout. As it has been mentioned before, preventing burnout is truly a challenge and what might work in one work setting, might not work in another. The most interesting area to be able to look into in relation to burnout prevention is psychological immunity. This research found that psychological immunity was one of the most important protective factors against burnout. If this would show to be the case in more studies, it would be an important area to suggest for burnout prevention. Research could investigate the levels of psychological immunity in health care workers together with the levels of burnout. If it would turn out that the levels of psychological immunity are low and that the levels of burnout are high in some hospitals or wards, interventions targeting at strengthening nurses psychological immunity could be implemented. This of course sounds easier than it would probably be in real life. How can we strengthen psychological immunity? How can we strengthen psychological immunity in nurses? The techniques to attain stronger psychological immunity in nurses (if shown to be low) could be a challenge for future research. However, just as Garrosa et al. (2006) have mentioned, that interventions to decrease burnout might be
more efficient if they would be directed at increasing nurses personality instead of for example only concentrating at diminishing work-related factors. Thus, in light of this suggestion, increasing nurses psychological immunity as a type of prevention might be investigated in future research. Another idea would be to introduce more than one variable for prevention. Maybe social support together with strengthening the psychological immunity would give results in hospitals as prevention intervention. The only way to find out is through research and hopefully this study has given two ideas for prevention where one has already been suggested (social support) and one which seems to be new in relation to all aspects of burnout not just prevention (psychological immunity). 6.3. LIMITATIONS Due to the small sample size (N=187) in this study the findings cannot be generalized to the Hungarian and Swedish emergency nursing population in general and neither on the general Hungarian or Swedish population. When looking at the comparisons between the Hungarian and Swedish emergency nurses, it is important to keep in mind the age differences between the two samples. It turned out that the Swedish nurses were in general older than the Hungarian nurses and thus this might be the reason why the majority of the Swedish nurses were married, had higher education, and more children than the Hungarian nurses. However, it must also be kept in mind that the questionnaires were distributed on equal terms in both countries and the differences might be a trend in the Swedish and Hungarian health care system. It could possibly be that Swedish nurses in general are older than Hungarian nurses. Also, in the samples there were differences between hours worked per week where the Swedish nurses worked less than 40 hours per week to a higher degree than the Hungarian nurses. Also, the Hungarian nurses worked more than 40 hours per week to a higher degree than the Swedish nurses. Again it has to be emphasized that questionnaires were distributed on equal terms in both countries and the differences for the inequalities in hours worked per week could also be a cultural difference. It is maybe possible that the hospitals in Sweden are structured differently than in Hungary and that the nurses are working generally less than 40 hours.
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University of Eötvös Lorand Hunga
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DEDICATION TO MY PARENTS; YOUR HARD
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ABSTRACT A great deal of research h
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3. METHOD……………………
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1. INTRODUCTION 1.1. PURPOSE OF THE
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1981). This questionnaire was and i
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oncology wards (Sherman, 2004). Esc
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(SWB). The meaning of SWB is how pe
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extent demographic variables, work-
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2. LITERATURE REVIEW 2.1. THE THEOR
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different countries in Europe and t
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Foxall, Zimmerman, Standley & Benee
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nurse were both negatively connecte
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elated to stress levels and job sat
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Altun (2002) has pointed out that b
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Demerouti et al. (2005) is also arg
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Halbesleben & Buckley (2004) argued
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Brewer & Shapard (2004) conducted a
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the third dimension of the burnout
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Table 1. Amount of nurses being bur
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environmental variables at the hosp
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and stress levels could be differen
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about a patient’s treatment witho
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Potter (2006) conducted a literatur
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Lin, Hsu, Chao, Luh, Hung et al. (2
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at work are underprivileged in comp
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instructions from their supervisors
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number of years worked as a nurse w
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psychosomatic health, after demogra
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environment, and support from the s
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urnout. The factor which has been h
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Diener & Tov (2005, in Kitayama & C
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form of for example life satisfacti
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develop burnout (see for example La
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Simoni & Paterson (1997) have also
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the psychological immune system (Ol
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positive effect of social support i
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Several authors have shown the effe
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support especially important in rel
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(1999), Tummers et al. (2002), and
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According to Maslach (1982), when i
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2.11. HOW CAN WE PREVENT BURNOUT? 2
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work-related safety in order to dec
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in the organization are not easy to
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at work, and on the nurses’ work-
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3. METHOD 3.1 STUDY POPULATION The
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the head nurse at the second meetin
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• Satisfaction with Life scale (D
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assess people’s satisfaction with
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positive accomplishment in the nurs
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Goal Orientation 0.63 0.52 Impulse
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23,71% Number of children 0-1 2-3 4
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It was shown that the Swedish nurse
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APPENDIX 3); a robust Welch-test fo
Page 109 and 110: Table 8: ANOVA results of work stre
Page 111 and 112: In the second part of the second hy
Page 113 and 114: would be found in the Swedish sampl
Page 115 and 116: The Monitoring-Creating-Executing S
Page 117 and 118: 4.6.3. Findings for Burnout and Per
Page 119 and 120: Table 17: Robust Test of Equality o
Page 121 and 122: Approach-Belief System (r=0.260, p
Page 123 and 124: p
Page 125 and 126: Approach-Belief System (1.01) and t
Page 127 and 128: Marital status Table 23: Burnout me
Page 129 and 130: generalized to other hospitals in S
Page 131 and 132: feeling inexperienced would result
Page 133 and 134: sample. Another researcher who foun
Page 135 and 136: 5.3. BURNOUT AND LIFE SATISFACTION
Page 137 and 138: the findings in connection to life
Page 139 and 140: salaries of health care system pers
Page 141 and 142: urnout simply shows that the area o
Page 143 and 144: feel supported at home and feel the
Page 145 and 146: and that lower personality scores g
Page 147 and 148: connection between age and burnout.
Page 149 and 150: connection to them was not thought
Page 151 and 152: and young nurses working in the int
Page 153 and 154: extensively researched all around t
Page 155 and 156: what if the Hungarian nurses would
Page 157 and 158: immunity between different countrie
Page 159: care workers (usually nurses). In s
Page 163 and 164: Aries, M. & Ritter, I. Z. (1999). N
Page 165 and 166: Brooks I. & Swailes S. (2002). Anal
Page 167 and 168: Chang, E. M., Bidewell, J. W., Hunt
Page 169 and 170: Cronin-Stubbs, D. & Rooks, C. A. (1
Page 171 and 172: Diener, E., Suh, E., Lucas, R. E. &
Page 173 and 174: Ghorpade, J., Lackritz, J. & Singh,
Page 175 and 176: Hupcey, J. E. (1998). Clarifying th
Page 177 and 178: Lakin, B., Leon, S. C. & Miller, S.
Page 179 and 180: Leiter, M. P. (1993). In Halbeslebe
Page 181 and 182: Maslach, C. (1982). Burnout: a soci
Page 183 and 184: Murrells, T., Robinson, S. & Griffi
Page 185 and 186: Piko, B. F. (1999). Work-related st
Page 187 and 188: Sherman, D. W. (2004). Nurses’ St
Page 189 and 190: Taris, T. W., Schreurs, P. J. G. &
Page 191 and 192: Wright, T. A. & Cropanzano, R. (199
Page 193 and 194: a. Age…………..years old b. Wh
Page 195 and 196: 6.I do not particularly like differ
Page 197 and 198: 4) I am interested in how you feel
Page 199 and 200: APPENDIX C ORIGINAL SPSS OUTPUTS Se
Page 201 and 202: Cases Reliability Scale: ALPHA Case
Page 203 and 204: Cases Case Processing Summary N % V
Page 205 and 206: RELIABILITY /VARIABLES=pici7 pici23
Page 207 and 208: Cases Case Processing Summary N % V
Page 209 and 210: Reliability Statistics Cronbach's A
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Section 6: Correlations of the test
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Emotional exhaustion_ mbi Depersona
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Table 11: Robust Tests of Equality
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ience d Worklo ad Stress related to
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Table 17: Coefficients(a) Unstandar
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Table 23: Excluded Variables(b) Par
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Table 30: Test of Homogeneity of Va
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a Predictors in the Model: (Constan
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5 6 country 4,870 ,772 ,342 6,305 ,
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Social support questionnaire ,145(b
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Being unprepaired and feeling inexp
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Social mobilizing capac. subscale_P
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Section 16: Correlations of the PIC
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Table 48: Correlations: (Group numb
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Positive thinking subscale_PIC I Se
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Positive thinking subscale_PICI Sen
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Approach-Belief System Monitoring-C
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Approach-Belief System Monitoring-
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Model 1 Variables Entered Work stre
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Change and Challenge orient. subsca
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Married -,160(c) -2,798 ,006 -,208
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Relationship with the patient’s r
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More than 5 years worked as a nurse
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Work and private life ,006(b) ,079
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Social creation capac. subscale_PIC
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6 7 Residual 6334,172 172 36,827 To
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Self-Efficacy subscale_PICI ,109(a)
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Significant other subscale_ social
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Stress related to tasks -,109(d) -1
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7 Age Relationship with patients Wo
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Estimate S.E. C.R. P Label Burnout
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country ss ws ls PIC Burnout PIC ,0
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Table 106: ECVI Model ECVI LO 90 HI
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coun try 2,41 8 dp -,723 ss ls PICI
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Table 120: tandardized Indirect Eff
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ment_mbi Emotional exhaustion_mbi D
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Personal accomplishment _mbi single
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2 Model 1 2 Married . a Dependent V
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Number of years at the current work
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edu Total How many years have you w
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Table 160: Chi-Square Tests Value d
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Death, dying Conflic ts with doctor
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Death, dying Conflic ts with doctor
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** Correlation is significant at th
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Estimate S.E. C.R. P Label e12 2,40
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APPMONSYS CREEXSYS SELFREGSYS Goal
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Table 184: RMSEA Model RMSEA LO 90
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Table 192: Correlations: (Group num
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APPMONSYS CREEXSYS SELFREGSYS Self-
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Table 204: NCP Model NCP LO 90 HI 9
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