Iran Journal of Nursing

Introduction
One of the most important factors that reduces the productivity and ability of nurses to effectively perform their duties at the workplace is job burnout. Job burnout is associated with many problems such as chronic fatigue, insomnia, family problems, negative attitudes and behaviors towards self, work, and patients, absenteeism, and job dissatisfaction. Studies have shown a significant relationship between the spread of COVID-19 and psychological problems such as stress and job burnout among nurses. Due to the contagious nature of this disease and the fear of infection, as and considering the high workload and contact with infected patients, nurses are at higher risk of occupational stress and work-family conflicts. Individual factors affecting mental health include demographic characteristics, personality traits, work-life balance, and support from family and friends. Considering the prevalence of COVID-19 and the high work pressure and workload among nurses during the pandemic, and given the sensitivity of nursing job and the harmful effects of job burnout on the quality of nursing care, the present study aims to examine the role of personality traits, work-family conflict, and social support in predicting the nurses’ job burnout during the COVID-19 pandemic .

Materials and Methods
This is a descriptive-analytical study with a cross-sectional design that was conducted from August to September 2021, coincided with the fifth wave of COVID-19 in Iran. Participants were 130 nurses who were selected by simple random sampling method from among the nurses working in internal, pediatrics, surgery, general, corona, and emergency departments of four hospitals in Ilam city. The inclusion criteria were consent to participate in the present study, having at least 6 months of work experience in the nursing profession, and being employed in a hospital involved in battling COVID-19. The data collection tools included a demographic form (surveying age, work experience, gender, marital status, type of educational degree, educational level, hours of work per week, working department, employment status, type of work shift, contact with COVID-19 patients, and increased working hours due to the outbreak of COVID-19), Maslach burnout inventory (MBI), NEO personality inventory, Carlson’s work-family conflict scale, and Zimet’s multidimensional scale of perceived social support. The electronic form of questionnaires were prepared using Google Forms and sent to the participants through WhatsApp and Rubika applications, along with the informed consent form. Data were analyzed using descriptive statistics, Pearson correlation test and multiple linear regression in SPSS software, version 26.

Results
Most of nurses (64.6%) were female, married (56.9%), with a bachelor’s degree (83.1%), and permanent employment (43.8%). It was reported that 95.4% of nurses were in contact with infected patients and 96.2% stated that their working hours had increased due to COVID-19. The mean age of participants was 34.96±6.91 years, ranged 24-55 years. The mean work experience of nurses was 9.62±5.59 years, and their mean hours of work per week was 63.0±14.5 hours.
The results of Pearson correlation test showed that emotional exhaustion domain of MBI had a significant relationship with the personality traits of neuroticism (r=0.31, P<0.05) and extroversion (r=-0.40, P<0.05) and a significant relationship with work-family conflict (r=0.32, P<0.05). The depersonalization domain of MBI was significantly related to all study variables (r=0.26, P<0.05). The personal accomplishment domain of MBI was related to all study variables (r=0.27, P<0.05), except for the personality trait of openness. 
The results of multiple regression analysis showed that the two variables of extroversion trait and work-family conflict were able to predict the emotional exhaustion domain of MBI (p<0.05). The direction of the effect of extroversion on emotional exhaustion was positive and the direction of the effect of family-work conflict was negative. The extroversion had the highest effect on emotional exhaustion (β=-0.351). Perceived social support did not show a significant effect on job burnout (P>0.05). The four variables of neuroticism, agreeableness, conscientiousness, and work-family conflict could significantly predict the depersonalization domain of MBI (P<0.05). The effect of neuroticism and work-family conflict on depersonalization was positive, and the agreeableness trait had the higher effect on depersonalization (β=-0.405). Also, three variables of extroversion, conscientiousness and work-family conflict were able to predict the personal accomplishment domain of MBI (P<0.05). The effect of extroversion and conscientiousness on personal accomplishment was positive and the effect of work-family conflict was negative. The work-family conflict had the highest effect on personal accomplishment (β=-0.260).

Conclusion
 In the present study, the findings showed that the two personality traits of extroversion and agreeableness were predictors of job burnout. The relationship of job burnout with perceived social support was negative and its relationship with work-family conflict was positive. The personality traits of extroversion and agreeableness and work-family conflict could predict job burnout. The lower support from friends and colleagues can increase the job burnout of nurses. The hospital authorities should use educational methods and provide more social and psychological support to reduce job burnout of nurses during a public health crisis. The education about how to deal with occupational stress and pressures should be provided to the nurses.

Ethical Considerations
Compliance with ethical guidelines
All participants signed the informed consent form and were assured of the confidentiality their information. This study was approved by the ethics committee of Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1400.240).

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization and design: Pegah Sharifian; Data collection, analysis and interpretation: Nina Shademan; Writing: Zeinab Kuchaki; Final approval: All authors.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses participated in the study for their cooperation.
 

References

1. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. lancet. 2020; 395(10223):514-23. [DOI:10.1016/S0140-6736(20)30154-9] [PMID]
2. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020; 323(21):2133-4. [DOI:10.1001/jama.2020.5893] [PMID]
3. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag. 2020;  28(5):1002-9. [DOI:10.1111/jonm.13014] [PMID] [PMCID]
4. Galanakis M, Moraitou M, Garivaldis FJ, Stalikas A. Factorial structure and psychometric properties of the Maslach Burnout Inventory (MBI) in Greek midwives. Eur J Psychol. 2009; 5(4):52-70. [DOI:10.5964/ejop.v5i4.240]
5. Malach-Pines A. Nurses' burnout: An existential psychodynamic perspective. J Psychosoc Nurs Ment Health Serv. 2000; 38(2):23-31. [DOI:10.3928/0279-3695-20000201-06] [PMID]
6. Arafa MA, Nazel MW, Ibrahim NK, Attia A. Predictors of psychological well-being of nurses in Alexandria, Egypt. IInt J Nurs Pract. 2003; 9(5):313-20. [DOI:10.1046/j.1440-172X.2003.00437.x] [PMID] 
7. Wessells Jr DT, Kutscher A, Seeland IB, Selder FE, Cherico DJ, Clark EJ. Professional burnout in medicine and the helping professions. New York: Routledge; 2013. [DOI:10.4324/9781315826080]
8. Mohammadnahal L, Mirzaei A, Khezeli MJ. [The effect of caring for COVID 19 patients on nurses'productivity and burnout (Persian)]. Nurs Midwifery J. 2021; 18(11):859-72. [Link]
9. Kokkinos CM. Job stressors, personality and burnout in primary school teachers.Br J Educ Psychol. 2007; 77(1):229-43. [DOI:10.1348/000709905X90344] [PMID] 
10. Borneo A, Helm C, Russell J. Safe and effective staffing: Nursing against the odds. London: Royal College of Nursing, 2017.
11. Sholibandari Rigizadeh S, Beshlideh K, Hashemi SheykhShabani SE, Arshadi N. [An Investigation of the relationship between neuroticism, work-family conflict, role overload, procedural justice, distributive justice and job control with job burnout in employees of Ahvaz Gas Company (Persian)] .J Psychol Achiev. 2011; 14(1):47-72. [Link]
12. Lu CQ, Siu OL, Chen WQ, Wang HJ. Family mastery enhances work engagement in Chinese nurses: A cross-lagged analysis. J Vocat Behav. 2011; 78(1):100-9. [DOI:10.1016/j.jvb.2010.07.005] [PMID] [PMCID] 
13. Oreyzi H, Javanmard S, Nouri A. [Relationship of work-family conflict with organizational justice, organizational commitment and vitality, by considering the role of expatriate and normal work schedules (Persian)]. Knowl Res Appl Psychol. 2014; 15(2):105-15. [Link]
14. Fang, YX. Burnout and work-family conflict among nurses during the preparation for reevaluation of a grade A tertiary hospital. Chin Nurs Res. 2017; 4(1):51-5. [DOI:10.1016/j.cnre.2017.03.010]
15. Paghoush A, Zarei E, Zeinalipour H, Dami Zadeh H. [The effect of work-family conflict on burnout with mediating role of life quality and job satisfaction amongst staffs in Sarkhoon & Qeshm Gas Treating Company. (Persian)] Knowl Rese Appl Psychol. 2017; 17(3):59-72. [Link]
16. Lambert EG,  Altheimer I, Hogan NL. Exploring the relationship between social support and job burnout among correctional staff. Crim Justice Behav. 2010; 37(11):1217-36. [DOI:10.1177/0093854810379552]
17. Reid KM, Taylor MG. Social support, stress, and maternal postpartum depression: A comparison of supportive relationships. Soc Sci Res. 2015; 54:246-62. [DOI:10.1016/j.ssresearch.2015.08.009] [PMID]
18. Ersoy-Kart M. Relations among social support, burnout, and experiences of anger: An investigation among emergency nurses. Nurs Forum. 2009; 44(3):165-74. [DOI:10.1111/j.1744-6198.2009.00139.x] [PMID]
19. Gombor A. Burnout in Hungarian and Swedish emergency nurses: Demographic variables, work-related factors, social support, personality, and life satisfaction as determinants of burnout [PhD dissertation]. Budapest: University of Eötvös Lorand; 2009. [Link] 
20. Yao Y, Yao W, Wang W, Li H, Lan Y. Investigation of risk factors of psychological acceptance and burnout syndrome among nurses in China. Int J Nurs Pract. 2013; 19(5):530-8. [DOI:10.1111/ijn.12103] [PMID]
21. Barr P. The five-factor model of personality, work stress and professional quality of life in neonatal intensive care unit nurses. J Adv Nurs. 2018; 74(6):1349-58. [DOI:10.1111/jan.13543] [PMID] 
22. Shafie Abadi A. [Career counseling and guidance on career choices theories (Persian)]. Tehran: Roshd; 2010. [Link]
23. Costa Jr PT,  McCrae RR.  Four ways five factors are basic. Pers Individ Dif. 1992; 13(6):653-65. [DOI:10.1016/0191-8869(92)90236-I]
24. Narimani M, Khanbabazadeh M, Farzaneh S. [The study of relationship between personality and job satisfaction in Ardabil Universitie's staff (Persian)]. J Ardabil Univ Med Sci. 2007; 7(1):77-83. [Link]
25. Farzianpour F, Ansari Nosrati S, Rahimi Foroushani A. [Survey of relationship between nurses shift and personality characteristics in private hospitals in Tehran City (Persian)], Journal of Payavard Salamat. 2017; 10(5):419-28. [Link]
26. Kim HJ, Shin KH, Swanger N. Burnout and engagement: A comparative analysis using the Big Five personality dimensions. Int J Hosp Manag. 2009; 28(1):96-104. [DOI:10.1016/j.ijhm.2008.06.001]
27. Maslach C, Jackson SE. The measurement of experienced burnout. J Organiz Behav. 1981; 2(2):99-113. [DOI:10.1002/job.4030020205]
28. Iwanicki EF, Schwab RL. A cross validation study of the Maslach Burnout Inventory. Educ Psychol Meas. 1981; 41(4):1167-74. [DOI:10.1177/001316448104100425]  
29. Zimet GD, Dahlem NW, Zimet SG, Farley GK.  The multidimensional scale of perceived social support. J Pers Assess. 1988; 52(1):30-41. [DOI:10.1207/s15327752jpa5201_2]
30. Souri A, Ashoori J. [The relationship between perceived social support, psychological hardiness and family communication patterns with quality of life among patients with type II diabetes (Persian)]. J Diabetes Nurs. 2015; 3(2):53-65. [Link]
31. Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. J Vocat Behav 2000; 56(2):249-76. [DOI:10.1006/jvbe.1999.1713]
32. Mansouri A, Rayani M, Shahdadi H, Lakzai H. [Comparison of marital satisfaction and work/family conflict among nurses with fixed and changing shifts (Persian)]. Community Health J. 2017; 9(2):65-74. [Link]
33. Costa PT, McCrae RR, Holland JL. Personality and vocational interests in an adult sample. J Appl Psychol. 1984; 69(3):390-400. [DOI:10.1037/0021-9010.69.3.390]
34. Kozako IN, Safin SZ, Rahim AR. The relationship of big five personality traits on counterproductive work behaviour among hotel employees: An exploratory study. Procedia Econ Financ. 2013; 7:181-7. [DOI:10.1016/S2212-5671(13)00233-5]
35. Powell SK. Compassion fatigue.Prof Case Manag. 2020; 25(2):53-5. [DOI:10.1097/NCM.0000000000000418] [PMID]
36. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. [DOI:10.1016/S0140-6736(20)30183-5] [PMID]
37. Ahmadi MS. [Predicting job stress and burnout based on personality characteristics of nurses (Persian)]. Knowl Res Appl Psychol. 2015; 17(2):98-107. [Link] 
38. Rayan A, Sisan M, Baker O. Stress, workplace violence, and burnout in nurses working in King Abdullah Medical City during Al-Hajj season.  J Nurs Res. 2019; 27(3):e26. [DOI:10.1097/jnr.0000000000000291] [PMID] [PMCID] 
39. Mohammadi-Fakhar F, Rafii F, Heshmat R, Haghani H. [Relationship between supervisor social support and burnout in nurses (Persian)] . Iran J Nurs. 2012; 25(79):63-71. [Link]
40. Wu P, Liu X, Fang Y, Fan B, Fuller CJ, Guan Z, et al. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 2008; 43(6):706-12. [DOI:10.1093/alcalc/agn073] [PMID] [PMCID] .