A systematic review of evidence based strategies to address nursing burnout through the lens of the Roy Adaptation Model

Abstract

<p><strong>Introduction: </strong>Burnout is a global problem affecting healthcare providers and the nursing workforce. Burnout is characterized by three dimensions originally described by Maslach: feelings of energy depletion or exhaustion, increased mental distance or negativism related to one’s job, and reduced professional efficacy. Nursing burnout is associated with decreased quality of patient care, increased patient infections and associated costs, reduced patient satisfaction, and poor nurse job satisfaction. Research on nursing burnout is gaining momentum as burnout gains recognition as a significant phenomenon. </p>

<p><strong>Objectives:</strong> The purpose of this presentation is to systematically review current literature for evidence based practices to address nursing burnout. The Roy Adaptation Model (RAM) will be used as a lens to systematically understand coping strategies and adaptation.</p>

<p><strong>Methodology:</strong> A search of the terms “burnout” “nursing” and “coping strategies” was conducted using the following databases: CINAHL, PsycINFO, and PubMed. Due to limited results, the search was expanded to include “stress” “healthcare provider” and “coping strategies.” Studies with rigorous research methods were analyzed. Evidence based interventions were related to Maslach’s dimensions of burnout and understood through RAM’s coping modes. </p>

<p><strong>Results:</strong> Seventeen studies exploring psychological coping strategies to address nursing and healthcare provider burnout were included in this review. Research was conducting on nurses and healthcare providers from a dozen countries. Four studies found mindfulness-based interventions to be highly effective. Support groups and stress management programs were found to significantly reduce burnout symptoms. Cognitive coping trainings related to emotional intelligence and other coping skills were also found to be beneficial. For continued efficacy, coping interventions should be maintained for one year, varied to address different stressors, and implemented at regular intervals. </p>

<p><strong>Conclusions:</strong> Strong evidence was found that mindfulness based stress reduction interventions (physiologic-physical mode) reduce burnout symptoms (exhaustion). Support groups (interdependence mode, role function mode) may also help ease symptoms of burnout (self-efficacy, depersonalization). Cognitive behavioral trainings (self-concept-group identity mode) improve burnout symptoms (exhaustion, depersonalization). Stress reduction programing reduces burnout symptoms in all three domains. Interventions likely enhance multiple coping modes. Further research is needed. RAM provides a holistic lens to understand and guide future research. RAM’s six step process may be used by nursing leaders and by nurses independently to assess burnout symptoms, implement coping supports, and assess adaptation.</p>