Iran Journal of Nursing

Background & Aims: Nursing is a holistic practice, and patient care is an essential component of this practice. The main task of nurses is to interact with patients, which leads nursing to an integral part of health care. Nurses play a key role in determining the quality of hospital services. The concept of quality nursing care refers to the patient's access to physical, communicative, psychological, and social needs, which affect patient satisfaction and wellbeing, as well as the better performance of healthcare organizations. Excessive work shifts, personal conflicts, facing death, lack of psychological support, conflict with physicians, and ambiguity regarding authority are among the influential factors in the quality of nursing care. Nurses communicate with the patient in a fully personal environment, which may not always bring about positive outcomes. The long-term exposure of nurses to workplace stressors could adversely affect their mental and physical health and lead to burnout, which deteriorates the quality of patient care. The most comprehensive definition of burnout has been proposed by Maslach and Jackson, who consider this syndrome to consist of three dimensions, including emotional exhaustion, depersonalization, and personal accomplishment. The most prominent symptom of this syndrome is emotional exhaustion when the individual feels pressured, and their emotional resources are depleted. Compared to other occupations, nurses are prone to severe burnout due to direct patient care. The main consequences of burnout include chronic fatigue, insomnia, negative attitudes toward self and clients, absence from the workplace, and job dissatisfaction. The negative consequences of burnout affect patient satisfaction as they reduce the quality of nursing care. Considering the sensitivity of the nursing profession and the debilitative effects of burnout on the efficiency and mental health of nurses, the present study aimed to investigate the correlation between the quality of nursing care and burnout of nurses in the teaching hospitals affiliated to Mazandaran University of Medical Sciences, Iran.
Materials & Methods: This cross-sectional, descriptive-correlational study was conducted on 125 nurses working in the teaching hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran during June-August 2020. The sample size included 125 nurses who were selected via random sampling from four teaching hospitals in Sari. The inclusion criteria of the study were willingness to participate, having at least a bachelor's degree in nursing, and at least two years of work experience in the nursing profession. The exclusion criterion was incomplete questionnaires. After selecting the participants and obtaining their written informed consent, the objectives of the research were explained to the subjects, they were assured of confidentiality terms regarding their personal information and instructed on completing the questionnaires. Data were collected using a demographic questionnaire (age, gender, marital status, education level, type of employment, shift work, work experience, level of interest in nursing), Maslach burnout inventory, and quality of patient care scale. Sampling was performed after the approval of the study protocol and receiving the ethics license from the Ethics Committee of Mazandaran University of Medical Sciences. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution tables, mean, and standard deviation) and analytical statistics (Mann-Whitney test, t-test, Spearman's correlation-coefficient, Kruskal-Wallis test). In all the statistical analyses, the P-value of <0.05 was considered significant. 
Results: In total, we enrolled 125 nurses with the mean age of 35.02 ± 6.82 years selected from four teaching hospitals affiliated to Mazandaran University of Medical Sciences (Zare Hospital: 18.4%, Imam Khomeini Hospital: 28%, Fateme Zahra: 26.4%, Buali Sina Hospital: 27.2%). Approximately 78% of the participants were female. The majority of the nurses (36%) were formally employed and had rotating work shifts (88%). In addition, most of the nurses had a BSc degree (90.4%). In this study, the mean quality of nursing care was estimated at 200.15 ± 26.01. The mean scores of nursing care quality in the psychosocial, relational, and physical dimensions were 84.29 ± 10.40, 40.23 ± 6.09, and 75.62 ± 15.32, respectively. The mean scores of burnout frequency in the dimensions of emotional exhaustion, personal accomplishment, and depersonalization were 21.44 ± 9.89, 17.18 ± 7.92, and 7.84 ± 7.35, respectively. The mean scores of the same dimensions in terms of the intensity of burnout were estimated at 25.19 ± 10.93, 31.26 ± 8.35, and 8.79 ± 7.78, respectively. The quality of nursing care with the subscales of burnout frequency, including emotional exhaustion (r=-0.369; P<0.001) and depersonalization (r=-0.471; P<0.001), had reverse and significant correlations. In addition, the quality of nursing care was directly correlated with personal accomplishment (r=0.226; P=0.011), which was very weak. The quality of nursing care with the subscales of the intensity of burnout, including emotional exhaustion (r=-0.362; P<0.001), personal accomplishment (r=0.289; P=0.001), and depersonalization (r=-0.501; P<0.001), also had significant correlations, which were very weak as well. In other words, reduced frequency or intensity of burnout was associated with the higher quality of nursing care. Our findings indicated a strong and direct correlation between the frequency and intensity of burnout (r=0.952; P<0.001). However, none of the demographic variables had significant effects on the quality of care and burnout of the nurses.
Conclusion: Undoubtedly, the provision of quality care to hospitalized patients will increase their satisfaction with hospitals. Given that nurses have the most interaction and contact with patients compared to other healthcare providers, they play a key role in achieving this goal. Our findings indicated a reverse correlation between burnout and the quality of nursing care. Therefore, special attention must be paid to this issue by healthcare authorities. It is hoped that by performing appropriate psychological interventions to manage the stressors of the work environment and decrease the burnout of nurses, a step will be taken toward increasing the quality of nursing care. One of the limitations of the present study was that the sample population only included the nurses working in teaching hospitals, and the nurses working in other hospitals (e.g., private hospitals) were not taken into account. Therefore, it is suggested that further investigations in this regard address this limitation.