Burnout 3 Thailand

[Leronne Washington]

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Methods: Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes.

Findings: Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection.

Conclusions: Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals.

Clinical relevance: Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.

Background: Burnout is associated with an increased risk for severe COVID-19. Few studies have examined burnout prevalence related to healthcare workers during the pandemic. This study investigated the burnout prevalence and contributing factors among HCWs, including medical staff and support staff, during the COVID-19 pandemic in an urban community in Thailand.

Methods: A cross-sectional online survey was distributed among HCWs in Bangkok, Thailand, from July-August 2021. The independent t-test and one-way analysis of variance (ANOVA) were used to compare the contributing factors and burnout items. Variable factors associated with burnout among HCWs were used in multiple linear regression models.

Conclusion: This study highlights the importance of addressing burnout among HCWs, in which female medical staff who slept less than six hours per day were associated with burnout. Our study further suggested that both intervention and identification are needed of frontline HCWs to prevent and reduce the risk of burnout, as the proportion of females compared to males is high. Thus, the government should provide support in these areas to prevent a humanitarian crisis.

This study investigated factors that impacted the mental health and burnout among kindergarten, primary and secondary school teachers in Thailand and presented a comprehensive intervention program to improve their wellbeing.

This cross-sectional survey study included 267 teachers from five public schools in Thailand. The survey instruments included the Depression, Anxiety and Stress Scale and the Maslach Burnout Inventory for Educators Survey, along with data on demographics, health behaviors, finances, professional work, relationships and resilience.

Besides providing an in-depth examination of mental health and burnout among teachers, this is the first study in Thailand to propose a comprehensive Teacher Wellness Program. This program recommends personal and professional development plans that public health personnel and school administrators could utilize to improve mental health and reduce burnout among teachers.

Teachers' work hours frequently extend beyond the classroom as they prepare lectures and grade papers. In the United States, teachers work roughly 50 hours a week [11]. Occupational stressors such as work overload and low salary are correlated with high stress and low job satisfaction; low job satisfaction was identified as a predictor of major depressive disorder among the teacher population [2, 4]. A study of elementary teachers in Brazil found that teachers who worked more had poorer mental health including depression, anxiety and sleep disorders [3]. Work environment and conditions not only impact the psychological wellbeing of teachers but also influence their ability to adequately perform job duties. Poor sleep and sleep disorders were associated with depression and impaired cognition which impacted attention, concentration and memory and led to low personal and work performances [3, 5, 12].

Teachers with depressive disorders were unable to create a productive classroom learning environment, contributing to a school climate in which students are unmotivated and ineffective in learning new skills [13, 14]. Stressed teachers were more likely to be absent from school, retire early and have a higher turnover in the profession [15]. A study of eighth-grade students and corresponding eighth-grade teachers reported that teachers' wellbeing positively correlated to student wellbeing and negatively correlated to student psychological distress [16]. Furthermore, positive student-teacher relationships were associated with higher student wellbeing and lower student psychological distress [16]. Additionally, high self-efficacy among teachers often correlated to lower job stress and higher mental wellbeing, allowing teachers to praise more students, devote more time to classes and help students succeed [17]; low self-efficacy was associated with a substandard performance [18].

A positive student-teacher relationship reduces stressors experienced within the classroom and creates a positive learning environment for both teachers and students. School principals promote such positive school climates by investing in teachers' professional growth [30]. Teachers who recognize the positive support implemented by principals experience lower levels of stress and higher levels of self-efficacy [32, 34]. On the other hand, teachers with a negative perceived school climate have increased levels of depression and anxiety [35].

The high workload within the teaching profession often intrudes on teachers' personal time. Family members may provide support to teachers by carrying out domestic responsibilities and mitigating the stressors experienced by teachers [28]. Friends may alleviate stress by creating space for teachers to take their minds off their occupational stressors [28]. Studies have indicated that relationships and support from family and friends were significant in promoting teacher resilience and alleviating stress and anxiety [5, 28, 36].

As Thailand experienced industrialization, predominantly younger Thais moved from rural areas to urban cities to chase educational and occupational opportunities, thus dismantling the close-knit support system within their communities. Individuals originating from rural areas suffered in the new competitive atmosphere in the industrial world [38]. Further, the lives of urban dwellers changed as they were able to afford a more luxurious lifestyle. These new urbanites no longer desired to return home to their families in rural areas, in turn attenuating the availability and accessibility of social support between family members [38]. A study of Thai parents reported that 16% of their adult children migrated to a new district, of which 73% were at least 100 kilometers away [39]. Because of the resulting reduction in social support, those living in urban areas reported poor mental health [38]. Consequently, elders who remained in rural areas also suffered from reduced social support. A study of older parents in rural Thailand indicated that social support deficits were correlated with higher levels of depression [40].

Additionally, unlike in Western cultures, Thais are still unfamiliar with the field of psychology and mental health resources, thus impacting the ability to provide counseling and therapy to Thai individuals who suffer from depression, anxiety and stress [41]. The minimal psychological treatment offered in Thailand encompasses both modern and traditional practices, often delivered by monks or nurses instead of mental health professionals [41]. The stigma commonly held against mental health among Thais fosters reluctance to report psychological distress; Thai individuals more frequently report somatic symptoms to express psychological distress, in contrast to Western individuals who are more willing to report psychological symptoms [42].

Insufficient studies have been conducted on mental health and burnout among teachers in Thailand. One study from Canada, England, Hong Kong and Thailand determined that self-efficacy among teachers partially mediated stress influenced by student behavior and workload [43]. Although the 1999 Educational Act shifted Thai teaching toward a learner-centered approach, Thai teachers lacked the resources and training to better ingrain high self-efficacy among their ranks [44]. Teachers are often viewed as second parents and trusted counselors; but they often feel like they are not doing enough, which creates a barrier to self-efficacy.

Teachers across the globe have indicated an array of variables influencing the severity of mental health issues that they faced. However, there is limited knowledge of counseling and treatment in addition to the under-development of mental health services in Thailand in comparison to other countries. Consequently, studies on depression, anxiety, stress and burnout among the Thai teacher population are scarce. By virtue of their occupation, teachers come into frequent contact with students during students' developmental stages; thus, teacher wellbeing influences student wellbeing in ways that influence the mental health trajectory of future generations. In addition to better understanding the psychological wellbeing of Thai teachers, contemporary and future Thai students may benefit from studies conducted on the mental health issues which affect and shape their classroom experiences.

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