A Study on The Relationship Between Burnout and Quality of Life Among Nurses In Thu Duc District Hospital, Vietnam

Purpose: The purpose of this study was to investigate the levels of the burnout among nurses, and to further explore the effects of the burnout on their quality of life. Methods: This study is a cross-sectional design. 280 nurses of Thu Duc District hospital in Vietnam were interviewed with structured questionnaires. Questionnaires included “Demographic Inventory”, “MBI scale”, and “SF-36 Scale”. T-test, ANOVA, Pearson’s correlation, and Regression Analysis were used to analyze data. Results: (1). The nurses had low and middle levels of the burnout, and moderate levels of the quality of life. (2) There were signicant correlations between demography and burnout, including gender, education, department, main work shift, and years in this department. (3) There is a signicant negative relationship in many sub-scales of the burnout and quality of life scale. (4) Education and burnout predicted 17.6% of the variance in quality of life. Conclusion: There were clear evidences that the nurses experienced burnout and then their quality of life was negatively affected. It is suggested that programs must be created to prevent burnout in nurses.

However, in Vietnam, the concept of burnout has been ignored, no research has addressed burnout. This study provide useful information, forecasting the burnout of nurses in Vietnam. Results of this research will help nurses to identify their burnout and improve their quality of life.

Purpose
The general purpose of this research aimed to investigate the level of burnout and the quality of life of nurses. Speci c objectives included as below: (1) to explore what demographic characteristics, levels of burnout and the quality of life among nurse, (2) to examine relationships between among demographic characteristics, burnout and the quality of life among nurse, and This study is a cross-sectional, descriptive, and correlational design.

Research Setting
The survey was conducted at Thu Duc District hospital. Thu Duc District hospital is a public general hospital in North East of Ho Chi Minh City. This hospital has 800 beds, dedicated to serving the local people. Most people come for medical examination and treatment with the support of universal health insurance. Every day around 4000 people visit the clinic. According to personnel statistics at Thu Duc Hospital in 2016, the total number of nurses is about 590. The ratio of nurses/beds is 1/1.2. This ratio is lower than the national average of 1.2/1 to 1.5/1 [8].

Research participants:
O cial nurses were recruited in the study. They were ready to participate in the study and signed in the consent form. These people were enrolled in the study. Absent nurses were excluded from the study.
Absences include postpartum leave, post-holiday leave, unpaid leave, sick leave, business trip, etc.
Sample size: Strati ed random sampling was used throughout the study period. In Krejcie and Morgan [10] at N = 600, the sample size representative of the nurses in this case was 234. The actual sample size was 280 (add 20% to prevent sample loss).

Research instruments:
A structured questionnaire, including "Demographic Inventory", "MBI scale", and "SF-36 Scale", in an interview format was conducted to collect data.

Validity and reliability
To check the validity of the questionnaire, the researcher consulted ve experts. The result was acceptable because authors have shown that S-CVI of 0.80 or higher was acceptable [11,12].
The results of pilot test showed that the reliability of the questionnaire was acceptable with Cronbach's Alpha of the MBI questionnaire of 0.824 and Cronbach's Alpha of the SF-36 questionnaire of 0.865.

Data collection process
Thirty nurses were recruited in a pilot study with the aim of clarifying the questionnaire and testing the reliability of the questionnaire as well. Participants were sent an email about the appointment with the researcher. Each participant was completed the interview for 30 minutes.
The researcher in this study instructed the participants how to complete the questionnaire and explain the variables. They did not present any personal comments (for example, suggesting answers, expressing emotions, answering right or wrong, etc.) in order to limit the bias caused by the researcher. Each individual participant was surveyed separately.

Data analysis
Data was analyzed using SPSS for Windows version 22.0. T-test, ANOVA, Pearson correlation, Scheffe's method, stepwise regression model was used for theoretical analysis, explaining the hypothesis of the study.

Demographic characteristics
Demographic characteristics are presented through 13 factors, 280 valid responses have been accepted.
Nurses participating in the study were young. From twenty one to thirty years old with 210 cases accounted for the highest rate of 75%. Female occupied the majority. Female/male ratio was 3.06 with 75.4% female and 24.6% male. The majority of participants were non-religious with 163 cases (58.2%).
Singles and marriages accounted for almost the same proportion and dominate. Most of participants did not have children. This rate was high 162 (57.9%). Intermediate degree nurses accounted for the majority, with 192 cases (68.6%). One hundred eighty-nine cases were not the main source of family income (67.5%). Lower middle income (> 24-94 million VND / year) account for most of 217 cases (77.5%).
Because this study uses strati ed sampling, the percentage of departments was predicted before the survey. The most common were Wards with 129 cases (46.1%). The majority of respondents were nurses with 256 cases (91.4%). Most nurses worked 8-hours shifts with 143 cases (51.1%). Among the nurses interviewed, most people who worked from 1-3 years (29.6%). Similarly, when surveying years in this department, I have found that nurses working in this department for 1-3 years were the majority (33.6%).
Burnout among nurse (Table 1) The quality of life among nurse (Table 2) Relationships between demographic characteristics and burnout College level had a lower level of burnout than other groups (F = 9.005, p <0.001). Nurses working in Wards and operating rooms (OR) had signi cantly higher levels of burnout than Outpatient department (OPD) with F= 4.009, p <0.001. For main work shift, the results showed that 8h shifts and administrative nurses had a signi cantly higher burnout score than 24h shifts (F= 4.821, p<0.01). Years in nursing had a relationship with burnout, but the Scheffé test did not show any speci c differences for each pair (F= 2.419, p <0.05). For years in this department, 7-9 years nurses group, who had higher levels of burnout than 1 year and below group (F = 3.201, p <0.05).

Relationships between demographic characteristics and the quality of life among nurse
Mean score the quality of life in the nursing college level was signi cantly higher than intermediate ( For Years in this department, nurses working less than 1 year had a signi cantly higher quality of life compared to other groups (F= 7.799, p<0.001).
Relationships between burnout and the quality of life among nurse (Table 3) The signi cant predictors of the quality of life among nurse ( Table 4)

Discussions
The majority of nurses participating in the study were young. Female was majority in this study. This is quite understandable because many nursing studies also show that women dominate this profession [4,13,14]. Non-religious nurses made up the majority of this study. For education, Intermediate degree nurses accounted for the majority. This result is consistent with cultural and religious characteristics in Vietnam. The frequency of singles and marriages was almost the same and predominates. Most of the subjects did not have children. Because the percentage of singles was the highest, this result was appropriate. Most of the participants were not the main source of family income. The nurses' age was so young that most of them were not the main source of family income. Comparing the results of this study and other studies in the World, I nd that nurses in Vietnam had a much lower income than many other countries. Most nurses in this study work with 8 hours shift. In Vietnam, the nurses work 8-hour shifts, which means there were 4 groups and they had continuously rotating shift. Among the nurses interviewed, most nurses had little experience. Age of the study participants was so young that this result is appropriate.
The mean scores of overall burnout were 2.38±0.75 (range from 0.40 to 4.55). The burnout among nurses was below average, even for internal factors (Emotional Exhaustion, Depersonalization and Personal Accomplishment). These results were lower than most other studies in the world. According to a study by Aytekin, Yilmaz, Kuguoglu 15 , the author examined 80 nurses, the results showed that nurses undergoing moderate burnout on Emotional Exhaustion and Personal Accomplishment. Or Kapucu, Akkuş, Akdemir, Karacan 16 found that Hemodialysis nurses had high scores for Emotional Exhaustion. In an international study on hospital care, Aiken and colleagues demonstrated that nurses were burnout at signi cantly higher rates than expected for health workers based on national standards [17]. Almost all newspapers in Vietnam mentioned the lack of serious human resources in nursing professional. At the hospital I surveyed also have a similar situation. Nurses often complain that they were exhausted and stressed in their work. However, the results in this study show that burnout levels were better than expected. In addition, health managers also need to consider the causes and factors that have caused burnout. Because I recognized that there were high score of participants. On the other hand, I also need to consider whether there exists nurses experienced burnout high, did not adapt, did not respond to the stress of the job and they had left their job. This nding suggested that although burnout levels were different among nurse, in general, burnout experiences in all three areas were low and relatively positive. However, the MBI score was not as predictable as mentioned above. It was only useful to compare the burnout levels between objects in the same context. However, I had di culty in considering burnout in the general context of nurses in Vietnam because there is almost no research in Vietnam had addressed this topic.
This was also a limitation of the research that need to be addressed and addressed in future studies.
The results of this study indicated that most of the nurses had moderate quality of life. Similarly, other studies had also shown that the quality of life of nurses was moderate [18][19][20]. The quality of life of health care workers was a topic that many scholars in the world were concerned about. The standard of quality of life includes not only income, wealth and employment, but also the social environment, environment, health (physical) and spiritual, educational , entertainment and private life [21]. As Milosevic, Golubic, Knezevic, Golubic, Bubas, Mustajbegovic 22 said that quality of healthcare depends on many factors, including health, quality of life and work ability of healthcare workers. The physical and mental health of the participants are as good as the higher the score. Physical health includes Physical activity (PF), Role limitations due to physical health (RP), Pain (BP), General health (GH). Mental health includes Role Limitations Due to emotional problems (RE), Energy/ fatigue (EF), Emotional well-being (EW), Social functioning (SF). The results of this study showed that physical and mental health were above average. This result is positive and relatively uniform across regions, this is different from other such studies [7,23,24].
The purpose of this study was to examine the relationship between burnout and quality of life. This result proved one of the original assumptions. There was clear evidence that the extent of burnout has a negative impact on quality of life in nursing professionals. Emotional Exhaustion, Depersonalization appears to be correlated negatively with most of item of QOL. Diminished Personal Accomplishment was negatively correlated with physical functioning, role emotional limitations due to health, emotional wellbeing. This result was similar to many studies around the world. Burnout was proven by many studies that had negative impacts on human health. Elevated rates of general physical illness appear to be more common in people experiencing higher degrees of burnout compared to people with lower degrees of burnout [25]. A longitudinal study of 406 social workers, found that employees with higher initial levels of burnout ultimately had more health complaints later in the study. Thus, the ndings of this study t in with the majority of burnout studies [26].
According to multiple regression analysis, the results showed that there were two variables of education and burnout that had statistically signi cant effects on the dependent variable. This means that, many factors in this study were found to be related to QOL. However, only education and burnout had signi cant levels of in uence, they contributed to the change of the QOL of nurses. The results clearly showed that burnout had more in uence than other variables. Research predicts that in the condition that the other variables did not change, when Burnout increases one unit, the quality of life decreases by 0.339. Education and burnout predicted 17.6% of the variance in quality of life.

Conclusions
Nurses had low and middle levels of the burnout. Quality of life among nurses was moderate. There is a signi cant negative relationship in many sub-scales of the burnout and quality of life scale. Education and burnout predicted 17.6% of the variance in quality of life. In clinical practice, health managers need to support nurses in improving their education and improving burnout to promote quality of life among nurses.