1.1 Study design and setting
This study was a cross-sectional research investigation conducted Base on Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE) from February to June 2020. The two following aims were examined in study “evaluation of occupational burnout, resilience, and parenting stress in nurses who care for COVID-19 patients” and “investigating the relationship between occupational burnout with resilience, parenting stress and demographic characteristics in nurses who care for COVID-19 patients”.
1.2 Participants and sampling
In this study sample size has been estimated 630 samples according to the study of Roy et al. With β = 80% and α = 0.05 and taking into account the 10% drop in each group. The participants were selected via convenience sampling. So nurses, who provided care to COVID-2019 patients in 5 hospitals affiliated with University of Medical Sciences in the west of Iran, were invited and selected via convenience sampling to participate in the study. The inclusion criteria were: being willing to participate, being in practice in one of the hospitals assigned for Covid-19 patients, and having at least one month of work experience in caregiving wards for patients with COVID2019. The subjects who failed to answer more than half of the items on their questionnaires or did not turn in their questionnaires were excluded. The subjects were asked to complete and submit the questionnaires—a personal (demographic) characteristics questionnaire, an occupational burnout scale, resilience scale, and, if they were parents, the parenting stress scale—online. The researchers sent emails and reminder messages to the participants, so that, the majority of the questionnaires (90%) were gathered in June. 420 of the subjects completed and returned the questionnaires via e-mail or a social network. Thus, the response rate was 66.7%. The nurses' reasons for not participating in this study were High prevalence of COVID2019 in Iran, heavy workload and intensive shifts, also infected with COVID2019.
1.3.1 The occupational burnout scale
Developed by Maslach in 1996, the Maslach Burnout Inventory is the most commonly used scale for measuring occupational burnout . The scale consists of 22 items which address three dimensions of occupational burnout: 9 items for emotional exhaustion, 5 items for depersonalization, and 8 items for personal accomplishment. The items measure the frequency and degree of burnout on an 8-point Likert scale: from 0 (very little) to 7 (very high). In the domain of emotional exhaustion, scores of 27 and above indicate severe emotional exhaustion, scores of 16 and below indicate slight emotional exhaustion, and scores of between 17 and 26 indicate average emotional exhaustion. In the domain of depersonalization, scores of above 13 indicate severe depersonalization and in the domain of personal accomplishment, scores of below 31 indicate low levels of personal accomplishment. The internal reliability of this scale to equal a Cronbach’s alpha of 0.80 . In their study, Baher et al. (2014) find the Cronbach’s alpha of the scale to be 0.79 .
1.3.2 The self-report Caregiver Burden Inventory
The Caregiver Burden Inventory was developed by Novak and Guest in Canada in 1988 to measure caregivers’ burden. The scale consists of 24 items which assess caregivers’ burden in five domains: time-dependence burden (5 items (1, 2, 3, 4, 5), developmental burden (5 items 6, 7, 8, 9, 10), physical burden (4 items 11, 12, 13, 14), social burden (5 items 15, 16, 17, 18, 19), and emotional burden (5 items (20, 21, 22, 23, 24). Completion of the scale requires approximately 15 minutes. The items are scored on a 5-point Likert scale ranging from 0 (Not at all) to 4 (Absolutely). The score range is between 0 and 96: 0 to 32 indicate low burden, 33 to 64 indicate moderate burden, and 65 to 96 indicate great burden . In their study conducted in Iran, Hormozi et al. report the reliability of the inventory to be 0.82, which is a satisfactory value .
1.3.3 The Parenting Stress Index-Short Form (PSI-SF)
Created by Abidin in 1995, the Parenting Stress Index comprises 3 subscales: parental distress (items 1 through 12), parent-child dysfunctional interactions (items 13 through 24), and child characteristics (items 25 through 36). The scale measures parental stress on a 5-point Likert scale ranging from 1 (=completely disagree) to 5 (=completely agree). . In their studies, Yeh (2001) and Reitman (2002) report the reliability of the scale to be 0.89 and 0.90 respectively [19, 20]. Assessing the reliability and validity of the scale in Iran, Shirzadi finds the reliability of the various dimensions of the index to be between 0.59 and 0.86, which are acceptable values .
1.4 Statistical methods
After data were collected, they were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) in SPSS v. 22. To investigate the relationship between occupational burnout on the one hand and resilience and parenting stress on the other, the researchers applied the chi-square test, independent t-test, and ANOVA. Significance level was set at 0.05. Subsequently, the variables of demographics, resilience, and parenting stress which were found to correlate with occupational burnout (p<0.25) were entered into multiple linear regression with the backward technique. Before executing the analysis of multiple linear regressions, the researchers examined the assumptions of normality of data, homogeneity of variance, and independence of residuals.