Burnout Evaluation among Nurses Working at the University Clinics of Lubumbashi , Democratic Republic of the Congo

Introduction: Burnout is a "physical and emotional fatigue syndrome, which leads to the development of inadequate self-image, negative attitudes at work with loss of interest and feeling for patients". The objectives of this study is to determine, the impact of stress and the emotional burden on nurses. Method: Our study is an observational transversal descriptive type, conducted at the teaching hospital in Lubumbashi, in the four major services, namely surgery, gynaecology, internal medicine and paediatric. A questionnaire test and scale of Maslach were used to assess the degree of burnout among nurses of this great institution. Results: 72.54% of our sample consists of women, 88.24% of nurses have over 11 years of work, 60.8% of nurses accuses overwork with the ripple effect, difficulties of organizing work, 58.8% do not adequately monitor their patients and do medication errors, 72.55% of nurses feel that pressure at work and affect patient monitoring, in regard to the scale of Maslach 39% have a professional exhaustion, 31.4% of depersonalization while 29.4% of personal achievement, per correlation to the different services, surgery leads with 33.3% of burnout on the scale of Maslach followed by gynaecology with 27%. Conclusion: We found that women are more concerned with burnout, and that is proportional to the number of years spent in hospital. The challenge of organizing patient monitoring and even administration of care, are the direct consequences of burnout.


Introduction
The Burnout syndrome is a disease characterized by a set of signs, symptoms and changes, in behaviour, function or biochemistry in the body of the affected subject.
The diagnosis of this state of tiredness is classified in the category of psychosocial professional risk which is secondary to an exposure of permanent and extended stress [1].
Christina Maslash defined burnout as "a syndrome of physical and emotional exhaustion, which leads to the development of inadequate self-image, negative attitudes at work with loss of interest and feeling for patients", her scale of burnout has 3 dimensions, namely: Burnout, depersonalization and decrease of personal accomplishment [2].

Is there any relation between stress and burnout?
Stress can be positive (great news announcement) or negative (bad news announcement).Fact is that human can adapt to different living conditions which enhances what is called the general adaptation syndrome by Hans Selye [3].
Physiologically, when we perceive a threatening situation, the physiological process will stimulate the adrenal medulla and the latter in turn will release the catecholamine (epinephrine, cortisol); these two hormones will be used to respond to stress and decrease it.Now, if the stress is on-going, there will be a build-up of adrenaline and cortisol to finally trigger either exhaustion or burnout.Stress occurs in everyone, is based on its own functional capability that responds by adapting [4].
Stress and burnout are the product of a human relationship where the individual and the environment are not separated entities, but the components of a process in which they influence each other and continuously.
For Cherniss, individual differences count as well in strategies developed to cope with stress; some adopt active methods to solve problems, others adopt negative attitudes and behaviours, and then overtime the burnout sets by Dumont [5].
Thus the transaction between the individual and his environment has three steps: • The first step is the perceived stress which comes from the unbalance between duties and resources of the individual.• The second step is the tension which it's an emotional response to the unbalance with physical fatigue, emotional exhaustion, anxiety as component.• Finally, the third step is attitudinal and behavioural changes.These changes in attitude and behaviour represent a "psychological leak" that sets in when a professional cannot relieve stress facing the problem directly.

Materials and Methods
Our study is transversal conducted in the teaching hospital in Lubumbashi, in four departments: Surgery, gynaecology, internal medicine and paediatric.We followed up on 51 nurses.
The assessment of occupational burnout among nurses was made possible by using the scale of Maslach.This allows evaluating the parameter according to the frequency and intensity; to note the frequency of each item 0-6.This scale consists of 22 items matching a categorization seven point (0=never; 6=daily) the tool is divided into three sub-scales as: • The emotional exhaustion (9 items).
The tool in its original version of Maslach and Jackson reproduces three subscales which respectively measure the following three dimensions: • The emotional exhaustion: The feeling of the employee being emptied and emotionally worked up.• The personalization: It's not a dissociative disorder that damages the self-consciousness as understood by the DSM IV R, but rather a decrease which reflects the development of impersonal negative attitude, and cynical toward people who are taken care of (student, patient, customer).• The reduced personal accomplishment at work: It's a disengagement and deep demotivation of the employee regarding work.

Results
We conducted a study at the University Clinics of Lubumbashi, out of 51 nurses in four major departments namely: Surgery, gynaecology, internal medicine and paediatrics.The average age of our respondents is 30 ± 3 years then that the male sex ratio is 2.6, the majority of respondents were married, 84.3% and 43.1% live in the municipality of Lubumbashi; 88.2% of the staff has a seniority of more or less 11 years in the exercise of their profession and 60.8% claim to have an overload.Results were analysed in Tables 1-10.

Discussion
The Lubumbashi University Clinics is the highest institution in our health care system; this is the reason for our choice of this teaching hospital for the current study.
The nursing profession is more exercised by women than men in Republic Democratic of Congo at CUL, 73% of the workforce consists of women, 11.76% who have less than 10 years of service and 88.24% over 10 years.
The study has showed that the nasogastric intubation followed by delivery is the main duties which exhaust the nursing staff and 60.8% of nurses are affected by overwork.
A study conducted in 2008 on the factor of burnout occurrence in home care nurses showed that the load of work is different compare to hospital care nurses in fact the latter take care of 8 to 10 patients from 8 am to 2 am, an average of 20 minutes per patient for 15 minutes of movement from one and another patient with a long chat and his entourage as well, the study concluded that the mental burden that can be presented by the intervention of a hospital nurse is more important.
Emmanuel Kulumishi Karume in his study shows that 64.70% of nurses encounter challenges due to: High number of patients, lack of materiel, increase of administrative duties, and lack of hygiene in the service.
Compare to the evaluation of burnout according to Maslach scale 39.2% of nurses present, an emotional exhaustion, 31.4% a depersonalisation issue while only 29, and 4% present with a decrease personnel accomplishment.
In Morocco, a research conducted by 3 Moroccan psychiatrists in five hospital (oncology, haematology, intensive care, department of burns, infectious pathology) revealed, among caregivers, 60% of caregivers scoring high for emotional exhaustion and depersonalization, 59% would been classified as "pathological cases", doctors and nurses being equal [6].
In Senegal Alexandre Dumont conducted a cohort study of 226 midwives in 22 hospitals, he showed that midwives have presented two years later a professional exhaustion (Burnout) and intended to leave their posts, or resign.Midwives were generally unhappy with their working conditions and emotionally exhausted, resulting in detrimental effects on quality of care [7,8].
For Martin, burnout is permanent among emergency officers and nurses in hospitals (casualty), he emits his hypothesis that the emergency doctors are slaves, the average working hours exceeds 60 hours a week in some understaffed services they're exhausted all the time and they run day and night on the floors, fight continuously to admit patients and even get insulted by everyone, including some of their colleagues [9][10][11][12].

Conclusion and Recommendation
Our study focused on the assessment of burnout in 51 nurses, we find that women are more concerned with burnout, and that it is proportional to years spent in hospital.The difficulties of organizing patient monitoring service and even the administration of care are the direct consequences of burnout.
We recommend a good time management, proper sanitation, improvement of working conditions to increase the psychological satisfaction, and maintain motivation to get good results.

Table 1
Distribution of nursing according to seniority.

Table 3
The difficulties of work organization.

Table 4
Careful monitoring of patients.

Table 5
Medication errors committed due to overwork.

Table 6
Impact of additional work on the safety and health of the patient.

Table 7
Occupation of nurse after administering care.

Table 8
Time slot found by the nurse to discuss and educate patients.

Table 9
Nursing distribution consequences for the scale of Maslach in services.

Table 10
Distribution of nursing consequences for the scale of Maslach.