Content uploaded by Eliseth Leão
Author content
All content in this area was uploaded by Eliseth Leão on Oct 07, 2014
Content may be subject to copyright.
This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted
PDF and full text (HTML) versions will be made available soon.
Prevalence of burnout syndrome in clinical nurses at a hospital of excellence
International Archives of Medicine 2014, 7:22 doi:10.1186/1755-7682-7-22
Vivian F Ribeiro (vifinotti@yahoo.com.br)
Celso Ferreira Filho (ferreira-celso@uol.com.br)
Vitor E Valenti (vitor.valenti@marilia.unesp.br)
Marcelo Ferreira (marceloferreira@gmail.com)
Luiz Carlos de Abreu (luizcarlos@usp.br)
Tatiana Dias de Carvalho (carvalho.td1@gmail.com)
Valdelias Xavier (eliasfisio@uol.com.br)
JapyAngeli de Oliveira Filho (japyoliveira@epm.br)
Pedro Gregory (gregoryp@gmail.com)
Eliseth Ribeiro Leão (eliseth.leao@einstein.br)
Natascha G Francisco (franciscong@yahoo.com)
Celso Ferreira (celsoferreira@epm.br)
ISSN 1755-7682
Article type Original research
Submission date 22 October 2013
Acceptance date 16 April 2014
Publication date 9 May 2014
Article URL http://www.intarchmed.com/content/7/1/22
This peer-reviewed article can be downloaded, printed and distributed freely for any purposes (see
copyright notice below).
Articles in International Archives of Medicine are listed in PubMed and archived at PubMed Central.
For information about publishing your research in International Archives of Medicine or any BioMed
Central journal, go to
http://www.intarchmed.com/authors/instructions/
For information about other BioMed Central publications go to
International Archives of
Medicine
© 2014 Ribeiro et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
http://www.biomedcentral.com/
International Archives of
Medicine
© 2014 Ribeiro et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Prevalence of burnout syndrome in clinical nurses at
a hospital of excellence
Vivian F Ribeiro
1*
*
Corresponding author
Email: vifinotti@yahoo.com.br
Celso Ferreira Filho
1
Email: ferreira-celso@uol.com.br
Vitor E Valenti
2
Email: vitor.valenti@marilia.unesp.br
Marcelo Ferreira
1
Email: marceloferreira@gmail.com
Luiz Carlos de Abreu
3
Email: luizcarlos@usp.br
Tatiana Dias de Carvalho
1
Email: carvalho.td1@gmail.com
Valdelias Xavier
1
Email: eliasfisio@uol.com.br
JapyAngeli de Oliveira Filho
1
Email: japyoliveira@epm.br
Pedro Gregory
1
Email: gregoryp@gmail.com
Eliseth Ribeiro Leão
1
Email: eliseth.leao@einstein.br
Natascha G Francisco
1
Email: franciscong@yahoo.com
Celso Ferreira
1
Email: celsoferreira@epm.br
1
Departamento de Medicina, Disciplina de Cardiologia, UNIFESP, Rua Sena
Madureira, 1500 - 5º andar, São Paulo, SP 04021-001, Brazil
2
Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, UNESP,
Av. HyginoMuzziFilho, 737, Marília P 17525-900, Brazil
3
Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av.
Príncipe de Gales, 821, Santo André, SP 09060-650, Brazil
Abstract
Background
Burnout syndrome can be defined as long-term work stress resulting from the interaction
between constant emotional pressure associated with intense interpersonal involvement for
long periods of time and personal characteristics. We investigated the prevalence/propensity
of Burnout syndrome in clinical nurses, and the factors related to Burnout syndrome-
associated such as socio-demographic characteristics, work load, social and family life,
leisure activities, extra work activities, physical activities, and work-related health problems.
Method
We conducted a cross-sectional, quantitative, prospective epidemiological study with 188
surgical clinic nurses. We used the Maslach Burnout Inventory (MBI), which is a socio-
demographic questionnaire and the most widely used instrument to assess Burnout syndrome
(three basic dimensions: emotional exhaustion, despersonalization and professional
underachievement). The socio-demographic profile questionnaire wascomposed of questions
regarding identification, training, time at work, work characteristics and personal
circumstances.
Results
The prevalence of Burnout syndrome was higher (10.1%) and 55, 4% of subjects had a
propensity to develop this syndrome. The analysis of the socio-demographic profile of the
nurse sample studied showed that most nurses were childless married women, over 35 years
of age, working the day shift for 36 hours weekly on average, with 2-6 years of post-
graduation experience, and without extra employments. Factors such as marital status, work
load, emotion and work related stress aggravated the onset of the syndrome.
Conclusion
The prevalence and propensity of Burnout syndrome were high. Some factors identified can
be useful for the adoption of preventive actions in order to decrease the prevalence of the
clinical nurses Burnout syndrome.
Keywords
Burnout, Professional, Syndrome, Nursing
Background
Nurses are commonly exposed to stress due to work overcharge [1-3]. In this context,
Burnout syndrome can be defined as long-term work stress resulting from the interaction
between constant emotional pressure associated with intense interpersonal involvement for
long periods of time and personal characteristics. Frequent Burnout syndrome symptoms
include emotional exhaustion and development of negative attitudes and feelings towards
work colleagues as well as to their own professional achievement [4].
Even though, Burnout syndrome is detected in professionals from various areas, prevalence is
particularly high in service and care workers, especially health and care ones [5]. Among
those, nurses have been the subject of several studies, because they experience constant
stressful labor situations, working in direct contact with patients who have different
expectations and degrees of suffering. For instance, a study conducted in Europe in 2011
showed that approximately 30% of nurses surveyed reported being exhausted or fatigued due
to work activities [6,7]. In addition, a British study found that approximately 42% of nurses
in England reported to be suffering from Burnout, whereas in Greece approximately 44% of
nurses reported a feeling of dissatisfaction at work and a desire to leave work. Lower
prevalence was reported in a survey in Germany, which estimated that 4.2% of that worker
population was affected by Burnout [6-8].
However, few studies in Brazil have investigated only nurses. In most cases, the number of
professionals in the institutions investigated is relatively small, leading to the joint study of
nurses, technicians, and assistants, whose professional activities differ in nature, complexity,
and emotional overload. Thus, it is difficult to determine the exact prevalence of this
condition among nurses in Brazil. Moreover, studies on Burnout syndrome in Brazil have
largely overlooked high-quality institutions that constantly strive to obtain health care quality
certifications. Thus, it is not known, for instance, whether the prevalence of the syndrome
among nurses in high-quality institutions differs from that observed in other institutions. That
knowledge is necessary to identify factors associated with the onset of the syndrome and to
develop plans for prevention and control.
In this study, we investigated the prevalence/propensity of Burnout syndrome in clinical
nurses, and the factors related to Burnout syndrome associated, such as socio-demographic
characteristics, work load, social and family life, leisure activities, extra work activities,
physical activities, and work-related health problems. Nurses with and without Burnout
syndrome, or Burnout propensity were compared.
Methods
We conducted a cross-sectional, quantitative, prospective epidemiological study with 188
surgical clinic nurses. The study was conducted from August to October 2012. One
individual refused to participate in the study, and twelve nurses were on sick leave. The study
site is a large private hospital in the city of São Paulo, considered the best hospital in Latin
America and a benchmark in quality and excellence [9].
We used the Maslach Burnout Inventory (MBI), which is a socio-demographic questionnaire
and the most widely used instrument to assess Burnout syndrome [10].
The MBI assesses how workers experienced their work, according to three conceptual
dimensions: emotional exhaustion, depersonalization and personal accomplishments. The
most widely used version of the MBI was established in 1986, it began to be used only for the
evaluation of the frequency, since the existence of high correlation between the two scales
was detected, and many studies found higher correlation (r = 0.80) [11-13].
The internal consistency of the three dimensions of the inventory is satisfactory, as it has a
Cronbach’s alpha ranging from 0.71 to 0.90 and test-retest coefficients ranging from 0.60 to
0.80 in periods of up to one month [14].
In Brazil there were several attempts to translate, adapt and validate the MBI, since the
researchers were concerned with overcoming the limitations of the low internal consistencies
of the factors depersonalization and personal accomplishments, however, the MBI has been
applied in more than 90% of the studies on Burnout worldwide [15]. According to some
authors, there was success in the development of MBI as a tool for the assessment of Burnout
in Brazil as indices of reliability Alpha Cronbach’s of 0.8014 [16-18].
The Maslach Burnout Inventory (MBI) assesses three basic dimensions: emotional
exhaustion (low: scores lower than 19; intermediate: 19–26; and high: scores greater than
27); depersonalization (low: scores lower than 6; intermediate: 6–9; and high: scores greater
than 10); and professional underachievement, which is inverse to the former two dimensions
(low: scores greater than 40; intermediate: 34–49; and high: scores lower than or equal to 33)
[19]. The socio-demographic profile questionnaire is composed of a set of close-ended,
multiple-choice, and open-ended questions, covering different spheres of life of the subject:
identification (sex, marital status, age, children), training, time at work, work characteristics
(employment status, time at work, other jobs, number of working hours per day, shift, weekly
rest, work impressions, pleasant and unpleasant work attributes), personal circumstances
(work related health problems, non-work related activities, dedication to family on weekends,
symptoms, and a self-assessment on stress).
The questionnaires were administered after nurses had signed the informed consent form and
approved by the Ethical Committee in Research (CAAE nº 04793112.4.3001.0071).
The data were described by absolute frequencies and percentages. The comparisons between
genders and work shifts were performed using Pearson’s chi-square test or Fisher’s exact test
in cases where expected frequencies were lower than five. The analyses were performed
using SPSS statistical software (SPSS Inc. Released 2008. SPSS Statistics for Windows,
Version 17.0. Chicago: SPSS Inc.). Significance level was set at 5%.
Results
High prevalence of Burnout syndrome
The detection of the three dimensions that characterize Burnout syndrome (concurrent
emotional tiredness, depersonalization, and professional underachievement) or of one or two
of those dimensions (indicative of predisposition to the syndrome) is shown in Figure 1.
Approximately 10% of the studied population had Burnout syndrome, and over half the
nurses interviewed had a propensity to develop the syndrome (presence of one or two
dimensions). We observed the prevalence, in decreasing order, of high emotional exhaustion,
professional underachievement, and depersonalization.
Figure 1 Burnout syndrome dimensions in clinical nurses from August to October 2012
at Albert Einstein Jewish Hospital, São Paulo, Brazil. ET = Emotional tiredness. DE =
Depersonalization. PD = Professional underachievement. BS = Burnout syndrome.
The analysis of the socio-demographic profile of the nurse population studied showed that
most nurses were childless married women, over 35 years of age, with knowledge of Burnout
syndrome, working the day shift and 36 hours weekly on average, with 2-6 years since
graduation, and without additional employments (Table 1).
Table 1 Socio-demographic characteristics of clinical nurses from August to October
2012 at Albert Einstein Jewish Hospital, São Paulo, Brazil
Variables
n(%)
Sex
Man 31 (16)
Woman 137 (83)
Age
20 a 25 17 (9)
26 a 30 54 (29)
31 a 35 55 (29)
35+ 62 (33)
Work shift
Day 111 (59)
Night 77 (41)
Marital status
Married 103 (55)
Single 71 (38)
Separated 3 (2)
Divorced 10 (5)
Widowed 1 (0.5)
Children
Yes 84 (45)
No 104 (55)
Time since graduation (years)
< 2 17 (9)
2–6 80 (43)
7–9 73 (39)
> 20 18 (10)
Work hours
36 172 (92)
> 36 16 (9)
The nurse has other employment
Yes 15 (8)
No 173 (92)
Table 2 also shows that most subjects interviewed did not have other activities other than
work, with no or rare weekends devoted exclusively to family, leisure activities, and social
life. Regarding the prevalence of work-related diseases, most subjects reported having no
problems. Among the subjects who reported having health problems, the main work-related
health complaints were musculoskeletal pain and emotional complaints.
Table 2 Extra-work activities, health problems, and health complaints reported by
clinical nurses from August to October 2012 at Albert Einstein Jewish Hospital, São
Paulo, Brazil
Variables
n(%)
Extra-work activities
YES 87 (46)
NO 101 (54)
Which ones?
Sport 36 (41)
Leisure 6 (7)
Voluntary and religious activities 4 (2)
Home 18 (20)
Education 28 (30)
Other 11 (13)
Health problems
YES 50 (27)
NO 136 (73)
Work related health complaints
Musculoskeletal pain 24 (48)
Emotional complaints 20 (40)
Headache 7 (14)
Other 7 (14)
Did not answer 1 (2)
Comparisons between subjects with Burnout propensity and Burnout
syndrome and subjects without Burnout syndrome
According to Table 3 the simultaneous presence of the three dimensions (emotional
exhaustion, depersonalization, and professional underachievement) indicates the occurrence
of Burnout syndrome, whereas the presence of one or two dimensions indicates a propensity
to develop the syndrome, which has a great impact on the work activity and worker life. The
proportion of women was higher in subjects with Burnout propensity than in subjects without
the syndrome, but no significant differences were observed between the two groups (p =
0.169).
Table 3 Comparisons between subjects with Burnout propensity and Burnout syndrome and subjects without Burnout syndrome and
demographiccharacteristics, work aloud and health problems from August to October 2012 at Albert Einstein Jewish Hospital, São
Paulo, Brazil
Dimension Classification
No Dimension
Propensity
P Burnout
p
N
%
N
%
N
%
Sex
Man 14 45,2 14 45,2 0,169 3 9,7 0,751
Woman 51 32,5 90 57,3 16 10,2
Work Shift
Day 46 41,4 55 49,5
0,021
10 9,0 0,140
Night 19 24,7 49 63,6 9 11,7
Age
20 a 25 yrs 4 23,5 9 52,9 0,290 4 23,5 0,249
26 a 30 yrs 15 27,8 35 64,8 4 7,4
31 a 35 yrs 19 34,5 30 54,5 6 10,9
35 yrs
27 43,5 30 48,4 5 8,1
Marital Status
Married 41 39,8 53 51,5
0,007
9 8,7 0,327
Single 15 21,1 47 66,2 9 12,7
Separeted 2 66,7 1 33,3 0 0,0
Divorced 6 60,0 3 30,0 1 10,0
Widove 1 100,0 0 0,0 0 0,0
Children
No 32 30,8 60 57,7 0,283 12 11,5 0,285
Yes 33 39,3 44 52,4 7 8,3
Weekly hours
36 hrs 56 33,3 93 55,4 0,995 19 11,3 0,327
Others workload 6 37,5 10 62,5 0 0,0
Weekends are devoted exclusively to family, social life and lesure activities
Never 1 25,0 2 50,0 0,411 1 25,0 0,089
Rarely or few times 30 29,1 59 57,3 14 13,6
Several times or almost always 19 38,8 28 57,1 2 4,1
Always 15 46,9 15 46,9 2 6,3
Others employment
No 58 33,5 98 56,6 0,235 17 9,8 >0,99
Yes 7 46,7 6 40,0 2 13,3
Extra- work activities
No 41 40,6 46 45,5
0,017
14 13,9 0,392
yes 24 27,6 58 66,7 5 5,7
Performance of physical activities
No 12 23,5 35 68,6 0,389 4 7,8 0,343
Yes 12 33,3 23 63,9 1 2,8
Work- related health problems
No 55 40,4 72 52,9
0,038
9 6,6
0,002
Yes 10 20,0 30 60,0 10 20,0
Pain
No pain complaint 60 37,3 87 54,0 0,380 14 8,7 0,073
One pain complaint 3 17,6 11 64,7 3 17,6
Two pain complaints 2 25,0 4 50,0 2 25,0
Three pain complaints 0 0,0 0 0,0 0 0,0
Emotional complaints
No emotional complaints 64 38,6 88 53,0
0,022
14 8,4
0,002
One emotional complaint 1 7,7 10 76,9 2 15,4
Two or more emotional complaints 0 0,0 4 57,1 3 42,9
Education activities
No 19 31,7 39 65,0 0,280 2 3,3 0,112
Yes 5 18,5 19 70,4 3 11,1
Home activities
No 21 30,4% 44 63,8 0,370 4 5,8% 0,553
Yes 3 16,7 14 77,8 1 5,6
Propensity = 1 or 2 dimensions.
Burnout syndrome = 3 dimensions.
Propensity = 1 or 2 dimensions.
Burnout syndrome = 3 dimensions.
Bold is significant.
The proportion of subjects who work the night shift was higher in subjects with Burnout
propensity than in subjects without the syndrome (p = 0.021).
The proportion of singles was higher in subjects with a propensity to develop the syndrome
than in subjects without the syndrome (p = 0.007).
The proportion of nurses who have extra-work activities was higher in subjects with Burnout
propensity that in subjects without the syndrome (p = 0.017).
The number of emotional complaints was higher in subjects with Burnout syndrome (p =
0.002) and Burnout propensity (p = 0.022) than in subjects without the syndrome.
The proportion of nurses with work related health problems was higher in subjects with
Burnout than in those without the syndrome (p = 0.002).
As expected, the frequency of work related health problems differed significantly among the
number of dimensions identified and was greater in subjects with Burnout syndrome. It
should be noted that approximately 40% of subjects who reported having no health problems
also showed no Burnout dimensions. Similarly, and as expected, we found a significant
positive association between the number of emotional complaints and the incidence of
Burnout (p= 0.038).
The number of subjects who perform physical activities was higher in subjects with Burnout
propensity than in subjects without the syndrome, but no significant differences were
observed (p = 0.389).
The number of subjects who never dedicate their weekends to family, leisure activities, and
social life was higher in subjects with Burnout propensity than in subjects without the
syndrome, but no significant differences were observed (p = 0.411).
Discussion
This study aimed to evaluate the prevalence of Burnout syndrome in a large sample of
clinical nurses and possible socio-demographic factors and activities associated with the
syndrome. Our results indicate that the prevalence of Burnout syndrome is high in this
sample, which was predominantly composed of childless, women without additional
employments, who rarely or occasionally dedicated weekends to family, leisure activities,
and social life. Moreover, most subjects did not participate in educational or sport activities in
addition to work, and reported having frequent health and emotional complaints.
This is the first study to establish the prevalence of Burnout syndrome in a group of Brazilian
population composed exclusively of clinical nurses working in a hospital of renowned
quality, with quality certifications for nursing professionals. Thus, our results should be
useful for defining the behavior of the syndrome and possible changes in prevalence due to
the adoption of specific prevention measures. Those measures should be beneficial not only
to the individuals affected, but also to their health institutions as Burnout syndrome directly
affects healthcare organizations, harming the quality of services and increasing the rate of
dissatisfaction and absenteeism.
The prevalence of Burnout in this study was10.1% higher than in previous studies conducted
in Brazil that range from 0 to 4.7% [8-10] and 49.7% in international studies [16-18].
One possible explanation for this difference is the heterogeneity of the sample population in
previous studies, which included not only nurses, but also technicians and assistants. Because
of the differences in work functions, in addition to the fact that they work at different hospital
areas, the prevalence of Burnout may also differ among these professionals, negating a direct
comparison with prevalence rates observed in this study, whose sample consisted of clinical
nurses only.
It should also be noted that the nurses at the institution evaluated perform several activities
after work hours and have to attend 53 hours of courses annually, in addition to participate in
congresses and intra-sectoral audits.
This accumulation of tasks may determine the short time devoted to family, leisure activities,
and social life, resulting in dissatisfaction, feelings of guilt and helplessness, reducing self-
esteem and, at a more advanced stage, professional achievement.
The prevalence rate of Burnout was 10,1% in our sample population, our results also showed
that more than half of the interviewees (55,4%) had a propensity to develop Burnout
syndrome, especially among single, childless subjects.
The fact that most of the sample population was composed of women over 35 years of age
may have influenced this result, because of the possible occurrence of feelings of inferiority
and frustration in light of current cultural standards that still consider married women with
children to be happier and more complete. Moreover, the lack of support and comfort from
family may contribute to excessive dedication to work, thus increasing the propensity to
Burnout.
Our results also indicate that the frequency of emotional and health (mainly musculoskeletal
pain) complaints was, as expected, higher in individuals affected by the syndrome. These
findings are consistent with the high rates of sick leave associated with Burnout, and confirm
the expectation that the emotional stress generated by the complexity of nursing work and the
direct contact with patients who experience different degrees of suffering and have different
expectations can lead to emotional overload in these professionals [19,20].
We also observed that the propensity to develop the syndrome was higher among nurses
working the night shift – an expected result considering that these professionals have no
regular sleeping and eating patterns. Moreover, feelings of inadequacy may be present,
because while everyone else is working, this professional sleeps, performing his/her activities
outside the regular routine adopted by society. Thus, the creation of flexible work schedules
and measures to adopt a different policy for professionals who work at night could help
reduce the prevalence of the syndrome.
Regarding the factors that may help prevent Burnout such as physical activity, we observed
no significant differences in the propensity (or prevalence) of Burnout between nurses who
performed and did not perform such activities. Even though physical activity is associated
with numerous health benefits, it can become another burden for individuals burdened with
other work activities.
It is not possible to establish a causal relationship between the frequency of sports practice
and the prevalence of Burnout because of the retrospective nature of our study and the
possibility that this factor may interact with other factors that were not analyzed. Thus, we
believe that sports should be encouraged in a healthy way, so that they can be recognized as a
source of pleasure and satisfaction.
We also observed that a higher frequency of educational and home activities were associated
with the propensity to develop the syndrome. This result is consistent with the notion that
such activities could represent an additional study and work overload for these professionals,
negatively affecting – at least in the short term – their physical and emotional health. Thus,
individuals who also study and manage their homes may not perceive the positive aspects of
these additional activities, and consider their work stressful.
This study has some limitations. Even though the onset of Burnout is a consequence of the
interaction between stress and constant work overload and personal, lifestyle, and personality
traits, this study did not evaluate individual variables such as how subjects perceive work and
their expectations towards work, as well as personal and personality traits that tend to prevent
Burnout. Thus, future studies that evaluate such characteristics may provide subsidies for the
development of prevention strategies that consider both institutional measures and personal
and lifestyle interventions to be made by each professional.
Conclusion
The prevalence and propensity for Burnout syndrome was higher specially among women,
single and childless subjects. Regarding the individuals who suffer from Burnout syndrome a
direct connection was made to health problems related to work. Individuals who did not have
any dimension did not report any health problems associated with work.
Working during night, being single and developing activities outside the work was present in
individuals who were prone to the syndrome.
Emotional complaints were present in both: Burnout and propensity.
Physicaly active female individual who dedicated time to family and social life were equally
as prone to the condition as those who did not and showed no significant statistical
difference.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
All authors participated in the acquisition of data and revision of the manuscript. All authors
determined the design, interpreted the data and drafted the manuscript. All authors read and
gave final approval for the version submitted for publication.
Acknowledgements
The funding body provided financial support to make all procedures and in the decision to
submit the manuscript for publication.
References
1. Godoy MT, Bouttelet D: Rethinking the care provided to nursing woman. J Hum
Growth Dev 2004, 14:63–68.
2. Mello DF, Rocha SM, Scochi CG, Lima RA: The nursing care to preterm and low birth
weight infant in home follow up. J Hum Growth Dev 2000, 10:49–60.
3. Madeira LM: The child’s discharge: implications for nursing. J Hum Growth Dev 1994,
4:5–11.
4. Carlotto MS, Palazzo LS: Burnout syndrome and associated factors: an epidemiologic
study of teachers. Cad Saúde Pública 2006, 22:1017–1026.
5. Nogueira MCF, Ramalho MA: Study in psychology. Maringa 2007, 12:123–132.
6. Sermeus W, Linda HA, Koen VH, Anne MR, Peter G, Moreno-Casbas MT: RN4CAST
consortium. BMC Nurs 2011, 10:6.
7. Galindo RH, Feliciano KVO, Lima RAS, Souza AI: Burnout syndrome among nurses in
a general hospital in the city of Recife. Rev Esc Enferm 2012, 46:420–427.
8. Moreira DS, Magnano R, Sakae TM, Magajewski FRL: Prevalence of the syndrome of
Burnout in nursing from a large hospital in southern Brazil. CadsaúdePública 2009,
25:1559–1568.
9. Franca FM, Ferrari R: Burnout syndrome and sócio demographic nursing staff. Acta
Paul Enferm 2009, 22:192–197.
10. Lautert L: The professional burnout: empirical study with nurses work in hospitals.
Gaúcha de Enfermagem 1997, 18:133–144.
11. Porto GG, Carneiro SC, Vasconcelos BC, Nascimento MM, Leal JL: Burnout syndrome
in oral and maxillofacial surgeons: a critical analysis. Int J Oral Maxillofac Surg 2014,
12:S0901-5027(14)00062-9.
12. Tamayo MR: Validation of the Maslach Burnout Inventory. [Abstract]. In Federal
Universityof Paraíba (Org.), III Congresso Norte-Nordeste de Psicologia 2003. Anais. João
Pessoa: UFPB; 2003.
13. Carlotto MS, Câmara SG: Factor analysis of the Maslach Burnout Inventory (MBI) in
a sample of teachers from private institutions. Stud Psychol 2004, 9:499–505.
14. Maslach C: Understanding Burnout. Cienc Trab 2009, 11:37–43.
15. Schaufeli WB, Enzmann D: The Burnout Campanionto Study and Practice: A Critical
Analysis. London: Taylor and Francis; 1998.
16. Albaladejo R, Villanueva R, Ortega P, Astasio P, Calle ME, Domingues V: Síndrome
Del Burnout em El persona de enfermeria em um hospital de Madrid. Rev Espanõla
Salud Pública 2004, 78:506–516.
17. Poghosyan L, Clarke SP, Finlayson M, Aiken LH: Nurse Burnout and qualyt of care:
cross- national investigation in six countries. Res Nursing Health 2010, 33:288–298.
18. Hanrahan NP, Aiken LH, McClaine L, Hanlon AL: Relationship between psychiatric
nurse work environment and nurse Burnout in acute care general hospital. Issues
Mental Health Nur 2010, 31:198–207.
19. Gómez MMN, Dodino CN, Aponte CF, Caycedo CE, Riveros MP, Martinez MPM:
Relationship between psychological profile, quality of life and stress em person nursing
care. Rev Univers Psych 2005, 4:63–75.
20. Hertel R: Burnout and theme d-surg nurse. Med-Surg Matters 2009, 18:1.
Figure 1
