Purpose: The purpose of the present study was to decrease burnout and intention to resign by practicing cognitive behavioral approach to nurses of the 3 years nursing clinical experience. Methods: Nurses (N = 180) who worked at acute-care hospitals and whose clinical experience was 3 years were requested. Nurses (n = 95, male 5, female 90) who were able to do participation at all the sessions were objects. The program was created and carried out for a nurse’s burnout with reference to cognitive behavior therapy. Evaluation of intervention was asked to complete a questionnaire that measured burnout (MBI), job stressors (NJSS), automatic thoughts (the shorter version of Japanese version ATQ-R), Irrational Belief Test for Nurses (IBTN), coping measure and whether or not they had an intention to resign. Measurement was performed 3 times of a baseline, after the end of session and follow-up. Analysis of covariance which adjusted the baseline level was performed. Result: According to the results, “helplessness”, “positive thinking” and “personal accomplishment” were significant (p < 0.01). According to the results of Friedman test, significant difference was observed in “emotional exhaustion” in the group with low degree of irrational belief (p < 0.10 ) and in the group with high degree (p < 0.05). With regard to the intention to leave the job, “wants to continue working as a nurse” was significant in the group in 3 months after intervention (p < 0.05). Conclusion: It is suggested that cognitive behavioral approach appears to be effective for reducing nurse’s burnout or intention to resign in nurses of the 3 years nursing clinical experience.
The turnover rate in nurses was 10.9% in 2012 in Japan. However, the tendency for the turnover rate to exceed the national average continues in the urban areas [
Consideration of an intervention model and development of “a burnout prevention program for nurses”.
The thing that how recognition works after receiving stimulation (stressor), results in burnout and performs a covariance structure analysis is investigated. As a result, it was found that there was a path following “stressor” => “irrational belief” => “negative automatic thoughts”, “positive automatic thoughts”=>“burnout” and a path which directly connected “stressor” and “burnout”. The goodness-of-fit of the structural model which combined these two paths appeared satisfactory [
According to the results of a study conducted by Ohue et al. [
chological education since provision of correct knowledge regarding stress or burnout to nurses can make them recognize their stress which they had never been aware of and knowing strategies against stress or burnout such as recognition change or a problem resolving technique is thought to reduce stress or burnout. Moreover, psychological education should not just end up by providing information [
Hence, the structure of the program as a package of “psychoeducation intervention + groupwork + homework” was designed. The format to provide the contents was a combination of a lecture-style psychological education to teach knowledge, group work to apply the newly learned knowledge, and homework to acquire the new recognition. This package was conducted for a total of 3 times; once a week for about 60 minutes per each time because of clinical convenience (
The objective of this study is to investigate effectiveness of a burnout prevention program using the cognitive behavioral therapy for nurses, which consists of correction of cognitive factors (irrational belief and automatic thoughts) and acquisition of coping behaviors.
1) Participants
According to the results that burnout risk is high among nurses with 3 years of clinical experiences, 3 shift- work in hospitals [
Psychoeducation | Groupwork | Homework | |
---|---|---|---|
First time | Psychoeducation regarding stress, burnout and related factors using a leaflet. | Discuss problems, stressful matters, and stress reactions. (Externalization of the problems) A facilitator summarizes each point and clarifies the problems using a help sheet. | Submit a workbook which contains today’s review and a thought recording table (events and feelings) once a week. |
Second time | Psychoeducation using a leaflet, which helps participants to learn that there is a way of thinking (thoughts) between stress and burnout and that feelings can change when the way of thinking changes even with the same event. | Argue against ideas under a stressful situation using a help sheet. | Submit a workbook which contains today’s review and a thought recording table (events, feelings, automatic thoughts and arguments) once a week. |
Third time | Psychoeducation about coping and problem solving techniques using a workbook. | Do activities with discussion in a group, based on five processes of the problem resolving technique using a help sheet. |
2) Evaluation indicators and points
Burnout and intention to leave the job were determined to be the primary endpoints in this study. Then, irrational belief, automatic thoughts, and coping were determined to be the secondary endpoints, which affect the primary endpoints.
a) Burnout: Maslach Burnout Inventory (MBI) was used [
b) Intention to leave the job: According to the categories introduced by Tsuchie et al. [
c) Irrational belief of nurses: The scale introduced by Ohue et al. was used [
d) Automatic thoughts: “the ATQ shorter form” introduced by Ohue et al. was used [
e) Coping: “the coping scale” introduced by Ozeki was used for evaluations of coping [
f) Measurement of stressors: Higashiguchi’s Nursing Job Stressor Scale (NJSS) was used [
Only the items of “conflict with other nursing staff,” “nursing nursing role conflict,” “qualitative workload,” “quantitative workload,” and “conflict with patients were used.
a)-f) were measured before intervention, after intervention and 3 months later. For (6), evaluations were made only before intervention.
3) Recruitment and procedure
Third year nurses who agreed to attend were recruited at hospital seminars, and their consent forms were obtained. They were placed into a group of five people, which was the size most suitable for discussions, and the program was conducted by the researcher, who was also a lecturer and facilitator. They were asked to fill out the evaluation indicators at the start of intervention, at the end of the session, and 3 months after completion of the session, totally 3 times.
4) Study design and methods of analysis
Considering that everyone can have irrational beliefs and that the degree of the beliefs affects burnout [
The following procedures were taken in analyses of evaluation indicators.
a) Firstly, the median of the scores for irrational belief was calculated, and the participants were classified into the low and high degree of irrational belief in order to evaluate the effects of burnout prevention program with a recognition change.
b) t-test was performed in order to compare the group with high degree of irrational belief and the low degree of irrational belief at the baseline.
c) After completion of each subscale session, analysis of covariance was performed using data obtained at 3 months after completion of the session as dependent variable, the groups with high and low degree of irrational belief as independent variable, and the baseline before intervention as covariance. When comparing the groups with high and low degrees of irrational belief at the timing of intervention, the baseline values could become extraneous variable and affect the values obtained after intervention or at 3 months after completion of the intervention. Therefore, analysis of covariance was performed in order to avoid statistics confounding.
d) Friedman test was performed on comparisons over time between groups with low and high degrees of irrational belief. In addition, if a significant difference was observed, the scores obtained at each time of intervention were compared using Wilcoxon signed rank test. Statistical significance was set at P < 0.10.
5) Ethical considerations
The protocol of this study was approved by the Hyogo University Ethics Committee. Written agreement of participation was received prior to this intervention from Directors of Nursing at the hospitals. Then, I provided explanations regarding this study with a written form to the nurses who attended the seminars, and the study was conducted only in the nurses who had submitted the consent. For the nurses, it was mentioned in a written form that the participants could make a free-will choice on participation in this study so they can disagree to participate or discontinue participation in this study without having any disadvantages and that data would not be used outside this study. It was also explained that the data obtained were processed statistically using code numbers.
1) Participation in the study
Informed consent for participation was obtained from 126 nurses (Response rate 70%). During the intervention 21 more nurses dropped out due to working time conflict, consequently 105 nurses completed the program. Furthermore, 10 nurses dropped out during the follow-up period. Therefore, 95 nurses (5 male, 90 female) were analyzed (
2) Basic characteristics
The participants included 5 male and 90 females with the mean age of 25.06 ± 4.18 years old. With regard to marital status, 5 participants were married and 90 were single. The final educational backgrounds were nursing schools in 70 participants, universities in 15, and advanced course in 10. Their current departments were 14 participants in outpatient clinics, 4 in operation rooms, 10 in ICU, 68 in wards. Since difference was not observed
between female and male nurses in irrational beliefs of nurses [
3) Baseline comparisons between the groups with high and low degrees of irrational beliefs
Using the median value, 36, of the scores for irrational belief, 95 participants were classified into the groups with low (N = 48) and high (N = 47) scores. In these 2 groups, t-test was performed in order to make baseline comparisons regarding 5 subscales of NJSS to measure stressors, 3 subscales of IBTN to measure irrational beliefs, 2 subscales of ATQ-R shorter form to measure automatic thoughts, 3 subscales of the coping scale to measure coping, 3 subscales of MBI to measure burnout, and 3 categories for the Intention to leave the job (
As a result, for irrational beliefs, significant differences were observed in the total score (p < 0.001), problem avoidance (p < 0.01) and dependence (p < 0.05); the scores were higher in the group with high degree of irrational belief compared to the group with low degree. With ATQ-R, significant differences were observed in Negative evaluation of the future (p < 0.05) and Self-blame (p < 0.05), indicating that the scores for Negative evaluation of the future and Self-blame were higher in the group with high degree of irrational belief than in the group with low degree; That is, participants with high degree of irrational beliefs show higher negative evaluation of the future and self-blame. In the coping scale, no significant difference was observed; That is, there was no difference in coping in association with high or low degree of irrational beliefs. A significant difference was observed in emotional exhaustion (p < 0.05) with MBI, suggesting that emotional exhaustion is more prominent in the group with high degree of irrational belief compared to the group with low degree. With regard to the intention to leave the job, a significant difference was observed in “desire to change the hospital/department” (p < 0.05), indicating that the group with high degree of irrational beliefs showed a higher rate in willingness to change the hospital or department compared to the low degree group. On the other hand, no significant difference was observed in all subscales with NJSS; perception of stressors was not associated with high or low degree of irrational belief or automatic thoughts.
4) Effects of the program
Analysis of covariance was performed by setting after completion of intervention and 3 months after the completion of intervention as dependent variables, and the groups with high and low degree of irrational beliefs
A low irrational belief group (N = 48) | A high irrational belief group (N = 47) | ||||
---|---|---|---|---|---|
NJSS | M | SD | M | SD | t |
The total strain | 70.11 | 10.98 | 73.00 | 9.91 | 0.57n.s. |
Conflict with other nursing staffs | 18.44 | 3.57 | 20.63 | 3.20 | 1.32n.s. |
Nursing role conflict | 14.22 | 3.19 | 12.88 | 3.60 | 0.82n.s. |
Qualitative work load | 15.22 | 2.86 | 16.13 | 2.70 | 0.67n.s. |
Quantitative work load | 16.67 | 2.69 | 18.00 | 1.60 | 1.22n.s. |
Conflict with patients | 5.56 | 1.24 | 5.38 | 2.07 | 0.02n.s. |
IBTN | |||||
The total of an irrational belief | 35.22 | 1.86 | 42.50 | 4.21 | 4.71*** |
Problem avoidance | 9.78 | 2.54 | 13.13 | 3.31 | 2.35** |
Helplessness | 12.00 | 1.87 | 13.88 | 2.90 | 1.60n.s. |
Dependence | 13.44 | 1.59 | 15.50 | 2.14 | 2.27* |
ATQ-R | |||||
Negative evaluation of the future | 12.44 | 4.48 | 17.50 | 5.37 | 2.12* |
Self-blame | 16.22 | 3.60 | 19.88 | 3.00 | 2.26* |
Positive thinking | 20.33 | 2.00 | 17.88 | 3.52 | 1.80? |
Coping | |||||
Problem-focused Coping | 7.00 | 2.45 | 8.13 | 2.47 | 0.94n.s. |
Emotion-focused coping | 6.11 | 2.03 | 5.50 | 2.62 | 0.54n.s. |
Escape-avoidance coping | 7.78 | 4.15 | 7.63 | 4.84 | 0.07n.s. |
MBI | |||||
Emotional exhaustion | 16.44 | 3.40 | 19.88 | 3.48 | 2.05* |
Depersonalization | 12.56 | 3.81 | 15.38 | 6.59 | 1.10n.s. |
Personal accomplishment | 15.33 | 4.85 | 15.00 | 4.72 | 0.14n.s. |
Intention to leave the job | |||||
Wants to quit working as a nurse | 2.44 | 1.13 | 2.88 | 1.73 | 0.62n.s. |
Wants to switch hospitals or departments | 2.11 | 0.78 | 3.38 | 1.30 | 2.46* |
Wants to continue working as a nurse | 3.67 | 1.32 | 3.25 | 1.49 | 0.61n.s. |
?: p < 0.10 *: p < 0.05; **: p < 0.01; ***: p < 0.001. n.s.: non significant.
as independent variables, and the scores before starting intervention as covariance (
a) Primary endpoints: changes in irrational belief, automatic thoughts and coping in groups with high and low degrees of “irrational belief”
According to the results, the primary effect of “helplessness” was significant (p < 0.10) in the group with ir-
Posttest | Follow-Up | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
A high irrational belief group | A low irrational belief group | A high irrational belief group | A low irrational belief group | |||||||
Estimated average | SE | Estimated average | SE | Main effect | Estimated average | SE | Estimated average | SE | Main effect | |
IBTN | ||||||||||
The total of an irrational belief | 38.27 | 2.40 | 34.31 | 2.20 | 1.04n.s. | 37.02 | 2.67 | 37.43 | 2.46 | 0.01n.s. |
Problem avoidance | 12.50 | 1.00 | 10.88 | 0.94 | 1.21n.s. | 11.29 | 1.02 | 11.52 | 0.95 | 0.02n.s. |
Helplessness | 11.71 | 0.73 | 9.92 | 0.68 | 3.00# | 11.48 | 0.80 | 11.35 | 0.75 | 0.02n.s. |
Dependence | 13.22 | 1.02 | 13.91 | 0.95 | 0.21n.s. | 14.01 | 0.83 | 13.77 | 0.78 | 0.04n.s. |
ATQ-R | ||||||||||
Negative evaluation of the future | 14.13 | 1.41 | 12.78 | 1.31 | 0.44n.s. | 14.42 | 1.55 | 14.85 | 1.45 | 0.04n.s. |
Self-blame | 18.70 | 1.38 | 16.16 | 1.29 | 1.58n.s. | 18.10 | 1.02 | 18.47 | 0.96 | 0.06n.s. |
Positive thinking | 20.99 | 0.77 | 17.79 | 0.72 | 8.45** | 22.19 | 1.06 | 18.72 | 1.00 | 5.17* |
Coping | ||||||||||
Problem-focused Coping | 8.87 | 1.10 | 7.34 | 1.03 | 1.00n.s. | 6.98 | 1.02 | 7.79 | 0.96 | 0.32n.s. |
Emotion-focused coping | 5.69 | 0.52 | 6.50 | 0.49 | 1.23n.s. | 5.66 | 0.80 | 5.97 | 0.76 | 0.08n.s. |
Escape-avoidance coping | 9.78 | 1.13 | 10.09 | 1.06 | 0.04n.s. | 9.67 | 0.96 | 9.52 | 0.91 | 0.01n.s. |
MBI | ||||||||||
Emotional exhaustion | 16.93 | 0.81 | 18.51 | 0.76 | 1.78n.s. | 15.27 | 0.92 | 15.98 | 0.87 | 0.28n.s. |
Depersonalization | 14.26 | 1.31 | 12.78 | 1.24 | 0.35n.s. | 12.44 | 1.19 | 12.95 | 1.12 | 0.24n.s. |
Personal accomplishment | 15.41 | 1.10 | 15.74 | 1.04 | 0.05n.s. | 17.89 | 0.74 | 14.88 | 0.70 | 8.67** |
Intention to leave the job | ||||||||||
Wants to quit working as a nurse | 2.29 | 0.27 | 1.97 | 0.26 | 0.73n.s. | 1.31 | 0.25 | 2.06 | 0.24 | 4.68* |
Wants to switch hospitals or departments | 2.74 | 0.48 | 2.68 | 0.45 | 0.01n.s. | 2.20 | 0.34 | 2.27 | 0.32 | 0.02n.s. |
Wants to continue working as a nurse | 3.90 | 0.28 | 3.54 | 0.26 | 0.87n.s. | 4.16 | 0.29 | 3.53 | 0.27 | 2.54n.s. |
Adjusted the value of the baseline: #: p < 0.10; *: p < 0.05; **: p < 0.01 n.s.: non significant.
A low irrational belief group (N = 48) | A high irrational belief group (N = 47) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Pretest | Posttest | Follow-Up | Pretest | Posttest | Follow-Up | |||||||
M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | |
IBTN | ||||||||||||
The total of an irrational belief | 35.22 | 1.86 | 33.67 | 4.09 | 35.78 | 6.59n.s | 42.50 | 4.21 | 39.00 | 5.76 | 38.88 | 4.42n.s |
Problem avoidance | 9.78 | 2.54 | 10.44 | 2.24 | 10.56 | 2.88n.s | 13.13 | 3.31 | 13.00 | 3.02 | 12.38 | 3.38n.s |
Helplessness | 12.00 | 1.87 | 9.56 | 1.88 | 10.78 | 2.54* | 13.88 | 2.90 | 12.13 | 2.42 | 12.13 | 2.70# |
Dependence | 13.44 | 1.59 | 13.67 | 2.35 | 13.44 | 2.46n.s | 15.50 | 2.14 | 13.50 | 2.88 | 14.38 | 1.85n.s |
ATQ-R | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Negative evaluation of the future | 12.44 | 4.48 | 11.56 | 4.36 | 13.56 | 4.56n.s | 17.50 | 5.37 | 15.50 | 4.38 | 15.88 | 5.00n.s |
Self-blame | 16.22 | 3.60 | 16.11 | 3.76 | 17.33 | 3.20n.s | 19.88 | 3.00 | 18.75 | 3.11 | 19.38 | 3.58n.s |
Positive thinking | 20.33 | 2.00 | 19.00 | 3.57 | 19.67 | 4.09n.s | 17.88 | 3.52 | 19.63 | 3.54 | 21.13 | 2.90** |
Coping | ||||||||||||
Problem-focused Coping | 7.00 | 2.45 | 7.33 | 2.78 | 7.56 | 3.00n.s | 8.13 | 2.47 | 8.88 | 3.14 | 7.25 | 2.92n.s |
Emotion-focused coping | 6.11 | 2.03 | 6.56 | 1.51 | 6.11 | 2.26n.s | 5.50 | 2.62 | 5.63 | 1.51 | 5.50 | 2.67n.s |
Escape-avoidance coping | 7.78 | 4.15 | 10.11 | 3.26 | 9.56 | 4.00# | 7.63 | 4.84 | 9.75 | 3.54 | 9.63 | 2.92n.s |
MBI | ||||||||||||
Emotional exhaustion | 16.44 | 3.40 | 17.11 | 3.48 | 15.44 | 2.55# | 19.88 | 3.48 | 18.50 | 3.78 | 15.88 | 2.70* |
Depersonalization | 11.22 | 4.82 | 12.33 | 4.18 | 12.33 | 4.44n.s | 15.38 | 6.59 | 13.13 | 3.80 | 14.75 | 3.28n.s |
Personal accomplishment | 15.33 | 4.85 | 15.89 | 4.73 | 15.00 | 4.66n.s | 15.00 | 4.72 | 15.25 | 5.95 | 17.75 | 3.65n.s |
Intention to leave the job | ||||||||||||
Wants to quit working as a nurse | 2.44 | 1.13 | 1.89 | 1.05 | 2.00 | 0.87# | 2.88 | 1.73 | 2.38 | 0.74 | 1.38 | 0.74* |
Wants to switch hospitals or departments | 2.11 | 0.78 | 2.44 | 1.13 | 2.00 | 0.87n.s | 3.38 | 1.30 | 3.00 | 1.41 | 2.50 | 1.07n.s |
Wants to continue working as a nurse | 3.67 | 1.32 | 3.67 | 1.12 | 3.67 | 1.22n.s | 3.25 | 1.49 | 3.75 | 1.28 | 4.00 | 1.31n.s |
#: p < 0.10; *: p < 0.05; **: p < 0.01 n.s.: non significant.
rational belief immediately after intervention. In other words, “helplessness” was significantly higher in the group with high degree of irrational belief compared to the one with low degree after the completion of intervention. However, no significant difference was observed in 3 months after the completion of intervention. Moreover, the results of Frieldman test revealed that there was a significant difference in “helplessness” in the group with low degree of irrational belief (χ2 = 7.56, p < 0.05) and the group with high degree of irrational belief (χ2 = 4.85, p < 0.10). According to the result of multiple comparisons, significant differences were observed in “helplessness” between pretest and posttest (p < 0.01) and between posttest and follow-up (p < 0.10) in the group with low degree of irrational belief. On the other hand, in the group with high degree of irrational belief, significant differences were observed in “helplessness” between pretest and posttest (p < 0.10) and between pretest and follow-up (p < 0.05). That is, intervention was effective in reduction of “helplessness” in both groups, but the effect continued only in the group with high degree of irrational belief. Although there was no statistical significance, the total scores with irrational belief was lower than the baseline at posttest in “problem avoidance” and “dependence” in the group with high degree of irrational belief but was higher or the same as the baseline in the group with low degree of irrational belief.
With regard to automatic thoughts, the primary effect of “positive thinking” in the ATQ-R shorter form was significant (p < 0.01) in the group with irrational belief after intervention, and it was significantly higher in the group with high degree of irrational belief compared to the one with low degree after the completion of intervention. Moreover, 3 months after the completion of intervention, the primary effect was significant (p < 0.05) in the group, and it was significantly higher in the group with high degree of irrational belief compared to the low degree group. According to the results of Friedman test, a significant difference was observed only in “positive thinking” in the group with high degree of irrational belief (χ2 = 12.62, p < 0.01). Multiple comparisons revealed that there were significant differences between pretest and posttest (p < 0.05), post test and follow-up (p < 0.05), and pretest and posttest (p < 0.05). Although no statistically significant difference was observed, the scores immediately after intervention were slightly lower than the baseline for both “negative evaluation of the future” and “self-blame” in the group with high degree of irrational belief, and those were also slightly lower than the baseline in 3 months after intervention. On the other hand, scores were slightly elevated in the group with low degree of irrational belief.
For coping, there was a significant difference in “problem avoidance/escape” in the group with low degree of irrational belief according to the results of Friedman test (χ2 = 5.10, p < 0.10). In addition, the results of multiple comparison revealed that there was a significant difference between pretest and posttest (p < 0.10). With coping, similar changes were observed in both groups with low/high degree of irrational belief; there was no significant difference observed between these groups. The scores increased in both groups immediately after intervention, but decreased slightly afterward. The improvement was sustained, however. That is, it seemed that coping brought the same effects in both groups.
b) Secondary endpoints: changes in burnout and Intention to leave the job in groups with high and low degrees of “irrational belief”
With regard to all subscales of burnout (MBI), no significant difference was observed after intervention, but the primary effect of “personal accomplishment” was significant in the group with MBI in 3 month after intervention (p < 0.01). That is, the effect was significantly higher in the group with high degree of irrational belief compared to the low degree group. According to the results of Friedman test, significant difference was observed in “emotional exhaustion” in the group with low degree of irrational belief (χ2 = 5.24, p < 0.10 ) and in the group with high degree (χ2 = 6.66, p < 0.05). The results of multiple comparison revealed that there was a significant difference between posttest and follow-up in the group with low degree of irrational belief (p < 0.05). On the other hand, a significant difference was observed between pretest and follow-up in the group with high degree of irrational belief (p < 0.05). In other words, improvement of “emotional exhaustion” was observed, but more interventional effects were observed in the group with high degree of irrational belief. Although no statistically significance was observed, “depersonalization” was reduced in the group with high degree of irrational belief.
With regard to the Intention to leave the job, no significant difference was observed after intervention, but primary effect of the Intention to leave the job “wants to continue working as a nurse” was significant in the group in 3 months after intervention (p < 0.05). That is, a significant decrease was observed in the group with high degree of irrational belief. According to the results of Friedman test, significant differences were observed in “wants to continue working as a nurse” in the group with low degree of irrational belief (χ2 = 6.87, p < 0.05) and in the group with high degree (χ2 = 6.87, p < 0.05). The results of multiple comparison revealed that there was a significant difference between pretest and post test in the group with low degree of irrational belief (p < 0.10). On the other hand, significant differences were observed between pretest and follow-up (p < 0.05) and between posttest and follow-up (p < 0.05) in the group with high degree of irrational belief (p < 0.05). Although no statistically significant difference was observed, thoughts of “changing the hospital/department” were reduced in both groups; the thoughts of “continuing the nursing job” increased in the group with high degree of irrational thoughts.
1) Study participation
180 nurses in their third year to participate in the study which received their consent for participation in the groupwork from 126 nurses were asked. The researchers themselves extracted the days when the nurses were on day-shift, and coordinated the groups. When conducting this study, trainings were held outside their day-time working hours without adjusting their work shifts. Therefore, it seemed that many nurses could not come due to their overtime work. The time frame of the sessions needs to be reconsidered in the future. At the same time, we should further verify the effectiveness of this program and encourage them to systemically incorporate the program into their workshops at the nursing department.
2) Effectiveness of cognitive behavioral therapy
By conducting this interventional program, irrational belief and negative automatic thoughts were reduced in the group with high degree of irrational belief. Then, burnout and intention to leave the job which were the consequences of irrational belief and negative automatic thoughts reduced. A partial improvement was observed in the group with low degree of irrational belief, but the change was not remarkable as had predicted. With regard to the items which showed nonstatistically significant differences, “helplessness” of irrational belief decreased and “positive thinking” of automatic thoughts increased in the group with high degree of irrational belief. With burnout, “emotional exhaustion” was reduced and “personal feeling of achievement” increased. As a result, the intention to leave the job “wants to quit working as a nurse” decreased significantly. This supports our hypothesis. Considering that burnout is deeply associated with irrational belief, it is shown that this program may be effective in nurses with irrational belief. This result supports the cognitive model suggested by Ohue et al. [
3) Study limitations and future issues
One of the problems in this study is dropout of participants. With regard to the dropouts, it is unclear if there are many dropouts in the group with high degree of irrational belief simply because of the time issue or because of the problem avoidance behavior associated with high degree of irrational belief. Therefore, it is necessary in the future to coordinate the working hours with a help from the nursing department so that they will not struggle with time and to increase the number of participants as well. The results of this study only evaluate the change of each scale in 3 months after intervention. Therefore, it seems that continuance of the intervention effects has not been adequately studied. In the future, it is necessary to accumulate long-term follow-up data and demonstrate continuation of reduction of burnout or Intention to leave the job among nurses.
TakashiOhue,MichikoMoriyama,TakashiNakaya, (2015) The Effect of the Group Cognitive Behavior Therapy in a Nurse’s Burnout and Intention to Resign. Health,07,1243-1254. doi: 10.4236/health.2015.710139