Materials
Measures of burnout, support, confidence in managing aged care residents, adaptive coping skills, demographics and work environment were used in this study.
Burnout. The Maslach Burnout Inventory Human Services Survey (MBI-HSS) (Maslach et al., 1996) was used to assess burnout in workers employed in the human services settings. There were three dimensions of burnout measured in this scale: emotional exhaustion, depersonalization and personal accomplishment. Emotional exhaustion (EE) referred to a depletion of “emotional tanks” at work and the feeling that one has “nothing left to give” psychologically (Maslach & Jackson, 1981; Maslach et al., 2001). Depersonalization (DP) referred to workers ‘cynical attitudes, negative feelings towards their clients’ issues and detachment from one’s workplace (Maslach & Jackson, 1981; Maslach et al., 2001). Personal accomplishment (PA) described feelings of satisfaction with work accomplishments (Maslach & Jackson, 1981; Maslach et al., 2001). The scale comprised 22 items. Using a 7-point likert scale (0 = never, 6 = often). Respondents indicated the extent to which each item described them with regards to their jobs. Sample items included “I feel emotionally drained from my work.”, “I feel I treat some recipients as if they were impersonal objects.” and “I feel I’m positively influencing other people’s lives through my work.” High levels of emotional exhaustion and depersonalization coupled with low levels of personal accomplishment indicated burnout in a worker. The reported reliability for the survey was acceptable, with Cronbach’s Alpha coefficients of .71 for personal accomplishment, .79 for depersonalization and .90 for emotional exhaustion (Duffy et al., 2009). In this study, internal consistency Cronbach’s alpha for each of the burnout dimensions were as follows: emotional exhaustion Cronbach’s alpha = .94, depersonalization Cronbach’s alpha = .70, personal accomplishment Cronbach’s alpha = .65.
Support. Three subscales (cohesion, trust and support) from the Organizational Climate Questionnaire (OCQ) (Koys & DeCotiis, 1991), were used to measure staff perception of support from co-workers and supervisors in the organization. Each subscale comprised of 5 items. For each item, respondents chose one out of five choices (where 1 = strongly disagree, 5 = strongly agree) to indicate whether they agreed or disagreed with each statement. Sample items included “People at work pitch in to help each other out.”, “I can count on my boss to keep the things I tell him confidential.” and “I can count on my boss to help me when I need it.” Scores across subscales were added to create a composite score for support, such that higher scores reflected higher levels of support. The reported reliability of the OCQ scale was high, with reported alpha coefficients ranging from .80 to .89 (Koys & DeCotiis, 1991). In this study, internal consistency Cronbach’s alpha of the composite of these subscales was high (α = .95).
Confidence. The Inventory of Geriatric Nursing Self-Efficacy (Self-efficacy measure) (Mackenzie & Peragine, 2003) was used to measure levels of confidence in managing geriatric nursing care challenges faced by professional caregivers. The inventory comprised 9 items including three items reflecting teamwork scenarios, three items reflecting resident scenarios and the other three items are family scenarios. Respondent indicated on a 7-point scale how confident they were in remaining calm, resolving the issue and achieving a positive result in relation to the scenarios (where 1 = not at all confident, 7 = very confident). Sample items included “You are extremely busy, you are behind in your work, and one of the residents is following you around and trying to grab your arm.” and “A colleague of yours is avoiding you for some reason. This is making your job difficult because you work closely with him.” Higher total scores indicated high levels of self-efficacy experienced by the individual. This measure was found to have good internal reliability with a Cronbach’s alpha of .96 and average item–total correlation of 0.83 (Mackenzie & Peragine, 2003). In this study, the internal consistency of the self-efficacy scale, as measured by Cronbach’s alpha, was .93.
Adaptive coping. The adaptive coping subscale of the brief COPE questionnaire (brief COPE) (Carver, 1997) - a shortened version of the COPE inventory (COPE) (Carver et al., 1989) was used to measure adaptive coping. The subscale comprised a total of 16 items, with two items measuring each of the following aspects: active coping, planning, use of emotional support, use of instrumental support, positive reframing, acceptance, religion, and humour. Respondents use a four-point scale to indicate how frequently they employed these coping strategies (where 1= I don’t usually do this at all, 4=I usually do this a lot). Sample items include: “I've been concentrating my efforts on doing something about the situation I'm in.” and “I have been thinking hard about what steps to take.”, and “I've been getting emotional support from others”. The Cronbach’s alphas for the brief COPE subscales have been found to range from .50 to .90 (Mohanraj et al., 2015). In this study, the internal consistency of the adaptive coping subscale Cronbach’s alpha was .90.
Demographics, work patterns and organisational climate were measured as covariates. Demographics characteristics included: gender (recorded 1= female, 2 = male), education (recorded 1 = postgraduate, 2 = undergraduate, 3 = Technical and Further Education (TAFE) diploma or certificate, 4 = Year 12, 5 = Year 11, 6 = Year 10, 7 = Year 9, 8 = Year 8, 9 = No school) and languages (recorded 1 = English, 2 = Italian, 3 = Greek, 4 = Cantonese, 5 = Arabic, 6 = Mandarin, 7 = Vietnamese, 8 = Other). Work patterns characteristics included in this study were: schedule (recorded 1 = regular day-time shift, 2 = rotating shift pattern, 3 = other) and workplace training received in the past 12 months (1 = No, 2 = Yes).
Three subscales of the Organizational Climate Questionnaire (OCQ) (Koys & DeCotiis, 1991) - autonomy, pressure and recognition - were used which measures staff perception of work independence, workload and skill recognition in the organization. Each subscale comprised of 5 items. For each item, respondents were required to choose one out of five choices (where 1 = strongly disagree, 5 = strongly agree) to indicate whether they agree or disagree with each statement. Items included “I determine my own work procedure.”, “I have too much work and too little time to do it in.” and “My boss is quick to recognize good performance.” The 15-items were summed to obtain organizational climate functioning scores, which ranged from 5 to 75 where higher scores indicated higher levels of positive organizational climate functioning. In this study, internal consistency Cronbach’s alpha was .60.
Statistical analyses
Data were summarised using descriptive statistics, such as mean, standard deviation, median and range, for continuous variables while frequency and percentage were presented for categorical variables. Internal consistencies were described using Cronbach’s alpha.
Hierarchical regression was conducted to examine the extent to which the purported predictor variables predicted burnout dimensions after controlling for covariates. Three regression analyses were conducted each with a dimension of burnout as the dependent variable. Covariates were demographics, work patterns and organisational climate (Step 1); predictor variables were support, confidence and adaptive coping (Step 2).
Assumptions relating to multicollinearity, outliers, normality, linearity, homoscedasticity, independence of residuals were tested. All assumptions were met. A p-value of < 0.05 was deem statistically significantly for all two-sided tests. The analyses was conducted using IBM SPSS Statistics version 27 (IBM Corp).
Assuming a medium effect size, a significance level of 5%, and power of 80%, a sample size of 97 was sufficient Gpower (version 3.1.9.4) (Faul et al., 2007), after assuming a 20% drop out rate (sample for analysis = minimum of 77).