A Survey of Burnout among Radiographers in South East Nigeria<br>

A Survey of Burnout among Radiographers in South East Nigeria

Research Article

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Erondu Okechukwu Felix^1*, Ugwu Anthony Chukwuka² and Amusiogo Osita²

¹Department of Clinical Imaging, Image Diagnostics, 9B Eligbam rd, Port_Harcourt, Nigeria

²Department of Radiography, Nnamdi Azikiwe University, Nnewi Campus, Nigeria

^*Corresponding author:

Erondu Okechukwu Felix
Department of Clinical Imaging
Image Diagnostics, 9B Eligbam rd
Port_Harcourt, Nigeria
E-mail: Okerons@yahoo.com

Received Sepetmber 17, 2012; Published October 29, 2012

Citation: Felix EO, Chukwuka UA, Osita A (2012) A Survey of Burnout among Radiographers in South East Nigeria. 1:454. doi:10.4172/scientificreports.454

Copyright: Â© 2012 Felix EO, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

This study was carried out to determine the various levels of Burnout among radiographers in South-East Nigeria. It was a cross-sectional and descriptive study, involving sixty-five diagnostic radiographers in South-East Nigeria who agreed to participate. The instrument used for data collection was a Maslach Burnout Inventory Questionnaire.

Sixty-five copies of the questionnaires were received and analyzed. Data analysis was done using both descriptive and inferential statistics. Statistical software, SPSS version 16.0 was used in the test of hypothesis of two independent means. P

Keywords

Burnout; Radiographers

Introduction

Burn-out among health care workers has been variously documented and has implications on their overall productivity.

Burnout has been variously defined to include job-related stress, physical and emotional exhaustion, and defensive coping [1,2]. It has been documented that certain professional groups are especially predisposed to burn-out. This may be true for professions entrusted with care of other people, and where public expectations are high.

Furthermore, environmental factors and work-place situations, especially those affecting job security and personnel management have also been implicated. The situations outlined above may simply describe the radiography profession in Nigeria. Acute shortage of manpower and less than ideal work environments may predispose Nigerian radiographers to chronic stress with resulting burn-out. Although burnout has been studied in a variety of health care professions, there is little empirical work concerning Nigerian radiographers.

Previous studies on stress showed that radiographers are experiencing high levels of stress, which obviously would predispose them to burnout.

This study aims at evaluating the levels of burnout of full-time clinical radiographers, examining variables that predict burnout among groups and suggest strategies to reduce burn-out.

Materials and Methods

This study involved sixty-five diagnostic radiographers working in South-Eastern Nigeria. South-East Nigeria is made up of Anambra, Enugu, Imo, Abia and Ebonyi State. This was a cross-sectional study carried out between March and June, 2011. The research instrument was a validated questionnaire adapted from the Maslach burnout Inventory (MBI), which was used to measure burnout amongst radiographers. The questionnaire consists of three sections: Sections A, B and C.

Section A

Consists of questions to measure individual demographic, job related variables and career related variables. Individual demographic variables include gender, age and marital status. Job related variables include employment sites (government or private hospital), job description (ultrasound and X-ray, X-ray only, etc), Rank (Chief Radiographer, Ass. Chief, Principal, Senior Radiographer), qualification (DCR, Bsc., Msc., others) and average number of cases done per day. The career related variables were total number of years stayed in the present job. Radiographers between the ages of 20-40 were classified as young, while those between the ages of 41-60 were classified as old.

Section B

Consists of the Maslach burnout Inventory (MBI). The Maslach burnout inventory has been used extensively in research and has been validated in subsequent studies.

The MBI is a 22-question instrument designed to measure the three stages of burnout syndrome, in terms of emotional exhaustion (9 items); Depersonalization (5 items) and Personal accomplishments (8 items).

Section C

Job Satisfaction (seven point semantic differential scale) which ranges from 1 (extremely unsatisfied) to 7 (extremely satisfied). Also, section C consists of questions to assess whether radiographers could identify methods of reducing stress/burnout in workplaces. Section C was designed to receive anecdotal information and comment on ways of coping and managing with chronic stress/burnout among Nigerian radiographers.

Method of Data Analysis

Descriptive and inferential statistics were applied. Descriptive statistics include mean, median, mode, standard deviation, minimum, maximum, frequency and percentages. SPSS Version 16.0 was used in the test of hypothesis of independent means. Inferential statistics like Pearsonâ€™s product moment correlation was done using SPSS Version 16.0. T-test was used to compare the mean values of depersonalization, emotional exhaustion and personal accomplishment. P-value

Results and Discussion

The participants in the study were radiographers working in South-Eastern Nigeria. Sixty-five copies of questionnaires were there, but only sixty-five copies were fully completed giving a percentage return rate of 80%. Radiographers within the age range of 20-60 years participated in the study, and their ages were categorized. Those within the age range of 20-40 were grouped as young, while radiographers within the age range of 41-60 were grouped as old. Hence, there are 48 (73.8%) young radiographers and 17 (26.2%) old radiographers. Participants were also grouped into male and female with 45 (69.2%) males and 20 (30.8%) females. There were 44 Govt. sector based radiographers (67.7%) and 21 private workers (32.3%). Fifty-seven (57) participants (87.7%) had basic qualification (Bsc. & DCR (Diploma of the College of Radiographers London), while 8 participants (12.3%) had post-graduate qualification (Msc.). For marital status, 30 participants (46.2%) were single and 35 participants (53.8%) were married. In ranking, participants were grouped into Chief and others. The chiefs consisted of chiefs, assistant chiefs and deputy directors. Others consisted of principal radiographers, senior radiographers and radiographers. Hence, Chief Radiographer consisted of 13 participants (20%), while others consisted of 52 participants (80%). Finally, for job description 30 participants (46.2%) did X-Ray and 35(53.8) did X-ray/ Ultrasound. All these information are represented in table 1.

Table 1: Demographic data.

The burnout levels of radiographer in South-East Nigeria are represented in table 2. The means and standard deviations for the three levels of burnout were got for all radiographers. Emotional evaluation has a mean value of 31.11 and standard deviation of 11.2. Depersonalization has a mean value of 5.63 and standard deviation of 3.25. Personal accomplishment has a mean value of 36.43 and a standard deviation of 7.31.

Table 2: Summary of burnout levels among radiographers in South-east Nigeria.

Patterns of Burnout among Different Groups

The perceived burnout levels were categorized among different groups of radiographers in table 3. The perceived burnout for male radiographers at emotional exhaustion level is 29.56 Â±11.03, and that for female radiographers is 34.60Â±11.11. The perceived burnout for male radiographers at depersonalization level is 5.44Â±3.01, and that for female radiographers is 6.05Â±3.79. Perceived burnout for male radiographers at personal accomplishment level is 37.73Â±7.37 and that for male radiographers is 33.50Â±6.39 and so on, as shown in the table 3. SPSS version 16.0 was used in the test of hypothesis of 2 independent means for the different categories of radiographers listed. For male and female radiographers, the P-value for emotional exhaustion is 0.09, 0.49 for Depersonalization and 0.03 for Personal accomplishment; therefore, there is a significant level in the perceived burnout levels of male and female for personal accomplishment. Significant difference exist in the perceived burnout levels of single and married radiographers for depersonalization and personal accomplishment (P-value=0.04 for DP and PA, respectively). For chiefs and other radiographers, the P-value for EE is 0.01, 0.02 for DP and 0.04 for PA. Therefore, there is a significant difference in the levels of burnout perceived between chiefs and other radiographers at EE, DP, and PA, respectively. However, there is no significant difference in the perceived burnout levels of male and female for PA and so on, as shown in the table 3.

Table 3: Burnout levels categorized among different groups of radiographers.

Comparison between Radiographers Burnout and Maslach Burnout Inventory Norm

The mean and standard deviation for the 3 levels of burnout were also included in table 4. T-test results indicate that the means for radiographers are significantly different from MBI norms across emotional exhaustion and Depersonalization, but there is no significant difference between the means of radiographersâ€™ personal accomplishment and that of the MBI norms. Radiographers had significantly higher level of emotional exhaustion (31.11) at P27). Radiographers have significantly lower level of depersonalization, 5.63 at P

Table 4: The mean and standard deviation for the three levels of burnout.

From the inference of table 5, it can be seen that the mean value of job satisfaction is 4.69, years of working experience is 5.0, no of cases done per day (workload) is 24. This shows that at mean value of 24 for number of cases done per day, radiographers are predisposed to high level of burnout. The table also showed that radiographers who are predisposed to burnout in this study would have got atleast 5 years of working experience. Also, job satisfaction â‰¤ 5 may be a major cause of increase emotional exhaustion and overall burnout.

Table 5: Comparison between radiographers burnout and maslach burnout inventory norms.

T-test Comparing Burnout among Radiographers in South-East Nigeria and Their United States Counterpart

A T-test comparison of burnout among radiographers in S/E Nigeria and that of the United States radiographer revealed no significant difference between the two groups across all the levels of burnout, as shown in table 6.

Table 6: Means, standard deviations for radiographers and MBI norms.

Correlation of Burnout Variables with Job Satisfaction, Number of Cases done per day and Years of Working Experience

Using Pearson Product Moment Correlation Coefficient, (Table 7a)shows that emotional exhaustion correlated negatively and significantly with job satisfaction (r =-0.07) and years of working experience (r=-0.32). From correlation statistics, job satisfaction and years of working experience have a negative and significant correlation with emotional exhaustion, while number of cases done per day correlated strongly and significantly with emotional exhaustion (r=0.53). Number of cases done per day (workload) appears to have the greatest impact on emotional exhaustion. Depersonalization has no significant correlation with job satisfaction, number of cases done per day and year of working experience. Personal accomplishment has a positive and significant correlation with job satisfaction and years of working experience, with the following value, job satisfaction (r=0.35) and years of working experience (r=0.26). However, personal accomplishment has no significant relationship with the number of cases done per day.

Table 7a: Contingency table showing pearson moment correlation of burnout variables with job satisfaction, number of cases done per day and years of working experience.

Correlation of Emotional Exhaustion with Depersonalization and Personal Accomplishment.

Correlation of burnout variables with each other, (Table 7b) shows a negative and significant relationship between depersonalization and personal accomplishment. Also, depersonalization has a positive and significant relationship with personal accomplishment; however, no significant relationship exists between personal accomplishment and emotional exhaustion.

Table 7b: Pearson product moment correlation of emotional exhaustion with depersonalization and personal accomplishment, and personal accomplishment with depersonalization.

Proposed National Norm of Burnout among Radiographers in South-East Nigeria

In the (Table 8a) is the categorization of burnout by Maslach Inventory norms, because of the significant difference in the burnout levels of radiographers in Nigeria; proposed national norms has been created in the study, in line with the MBI criteria (Table 8b). Radiographers with burnout level â‰¤ 16 for emotional, â‰¤ 6 for depersonalization and â‰ for personalization are regarded to have moderate burnout for the 3 levels. Radiographers with burnout level 17-26 for emotional exhaustion, 7-12 for depersonalization and 38-32 for personal accomplishment are regarded to have moderate burnout for the 3 stages, while radiographers with burnout level â‰ for emotional exhaustion, â‰ for depersonalization and â‰¤ 31 for personal accomplishment are regarded to have high level of burnout for the 3 levels. The proposed norm may be vital to radiographers in self assessment of their burnout level on daily, monthly or annual basis.

Table 8a: Categorization of MBI.

Table 8b: Proposed national norms of burnout among radiographers in Nigeria.

Content Analysis of Radiographers Comments

1. Employment of more radiographers (30.2%)

2. Use of ultramodern equipment with ergonomic design (20.2%)

3. Conducive working environment (17.1%)

4. Improved salary (11.7%)

5. Work rotation/duty scheduling (10.8%)

6. Radiographerâ€™s registration board of Nigeria should provide training on how to reduce stress/burnout among radiographers (5.00%)

7. Booking of cases (4.0%)

8. Avoid role ambiguity (1%)

Discussion

Radiography profession all over Nigeria is coming under increasing demand to serve the growing population, which obviously would lead to stress among radiographers and subsequently, burnout.

The result of this study indicates that Nigerian radiographers exhibit high levels of the first stage of burnout (Emotional exhaustion), which is work related with a value of 31.11 (MBI score>27). Emotional exhaustion may impede the process of care and reduce the radiographerâ€™s morale. The study also showed a rather low level of depersonalization with a score of 5.63 (MBI normed score<6). Moreover, radiographers seem to have a slightly higher personal accomplishment than the MBI norms (36.43), signifying high professional self-esteem.

Emotional exhaustion (EE)

Single radiographers (unmarried) have significantly higher level of burnout than married radiographers. Significantly higher level of burnout among junior radiographers than Chiefs is not surprising, as they do more of the clinical duty than the administrative cadre officers.

Depersonalization (DP)

Married radiographers have higher level of depersonalization than single radiographers. Junior radiographers have higher levels of depersonalization than those in the Chief cadre. This agrees with the findings of Ramirez et al., who stated that depersonalization is associated with age. Chief radiographers are obviously older than the junior radiographers, evident from the demographic data collected in the study, which further found that physicians aged 55, were more likely to experience high levels of depersonalization.

Radiographers who do X-ray/Ultrasound have higher level of depersonalization than those who do only X-ray. Radiographers with basic qualifications have higher level of depersonalization than their post-graduate counter-part. This can be explained by the fact that post-graduate radiographers have high training skills, and may be more experienced than their counterparts with basic qualification.

Personal accomplishment

The result of the study shows that male radiographers have high personal accomplishment than females, while chief radiographers accomplish more in the profession than junior radiographers. The study among nurses does not agree with this. They stated that nurses with 11 or more years of experience have lower levels of personal accomplishment. From the result of this study, chief radiographers have more years of working experience.

Comparison between Radiographers Burnout with Maslach Inventory Norm

The result of the study shows that Nigerian radiographers have high level of first stage of Burnout (Emotional exhaustion), when compared with MBI-norms (Table 4). They equally exhibited lower level of depersonalization, when compared to MBI-norms. However, there is no significant difference in their personal accomplishment, when compared with MBI-norms. This obviously may be connected to the statement of problem in this study, where few radiographers are challenged with the demands of serving a population of about 120 million. The reasons may be of high emotional exhaustion level. Although they experience high EE, they treat patients as human and hence, low depersonalization. However, greater percentage felt a great sense of personal accomplishment and self esteem, especially those with high years of working experience.Â

Comparisons of Radiographers Burnout with United States Radiographer

Comparison using T-test shows no significant difference in the level of burnout experienced by Nigerian radiographers and that of the United States counterpart, since P>0.05 despite the difference in geographic location, factors and ethnic differences as shown in table 6. Previous study conducted by Akroyd et al. [3] compared the burnout levels of US radiographers with that of radiation therapist. The result of their study showed that a significant difference exists in the levels of burnout perceived (EE, DP, and PA) between them. This similarity in the burnout levels when compared with Nigerian radiographers, irrespective of perceived differences in the work environment, should be an issue for further studies.

Relationship between Job Satisfaction and the Three Stages of Burnout

Table 7b shows correlation between perceived burnout level (Emotional exhaustion, depersonalization and personal accomplishment) with job satisfaction. The Pearson Correlation coefficient â€œrâ€ is (-0.07 P<0.05) for Emotional exhaustion, (-0.21 P<0.05) for Depersonalization and (0.35 P<0.05) for Personal accomplishment. This shows that emotional exhaustion and depersonalization correlated negatively and significantly with job satisfaction, while personal accomplishment correlated positively and significantly with job satisfaction. Job satisfaction has a direct negative effect on emotional exhaustion, and a direct positive effect on PA, which is in conformity with the result of this study. However, there is a negative and insignificant correlation between DP and job satisfaction which is contrary to a previous study. In this study they stated that job satisfaction correlated negatively with DP. They concluded that higher levels of job satisfaction could reduce level of burnout, while low level of job satisfaction could increase burnout level (Emotional Exhaustion) among employees, which was fastly supported by the result of this study. Radiographers with high job satisfaction have high personal accomplishment in the profession, as shown by the result of this study.

Relationship between Work Related Variable (Number of Cases Done Per Day, Years of Working Experience) and the Three Stages of Burnout

From table 7a, number of cases done per day correlated significantly and positively with the EE (r=0.53) P3] concluded that as workload increases, burnout also increases. They noted that as the number of scans increases, the EE of a sonographer/vascular technologist experience also increases. However, there is no significant relationship between number of cases done per day with DP and PA. Correlation between the years of working experience and the 3 stages of burnout shows that the years of working experience correlated negatively and significantly with the EE and positively with PA with correlations coefficient (r=0.32, p<0.05)for EE, and 0.26, ptable 3.

Correlations of burnout variables with each other shows that EE correlated significantly and positively with DP (r=0.29, p <0.05). This is supported by the findings where they concluded that EE had a direct positive effect on DP. Increased level of EE will lead to increased DP by radiographers. Personal accomplishment correlated negatively and significantly with DP; (r=-0.28) p

Proposed National Norms of Burnout for Radiographers as Derived from the Result of the Study

Another purpose of this study was to develop a national norm, which will guide all diagnostic radiographers in discharging their duties without experiencing burnout. Looking at the higher level of burnout experienced by radiographers in Nigeria when compared with the Maslach Inventory norms (Table 8b), it became necessary to derive a national norm which would guide practicing radiographers in Nigeria. It could serve as pencil and paper self assessment of burnout. The norm was derived with the following proposed formula:

Emotional exhaustion

>Mean +0.5 SD=High burnout

Moderate

Depersonalization

â‰¥Mean +0.5 SD=High burnout

Moderate

â‰¤Mean +0.5 SD=low burnout

Personal accomplishment

â‰¤Mean -0.5 SD=High burnoutÂ

Moderate

â‰¥Mean Â±0.5 SD=Low burnout

Radiographers who scored mean value of EE â‰¤ 26, 27-36, â‰ shall be categorized as having low, moderate and high burnout, respectively. Radiographers with mean value of Depersonalization â‰¤ 4, 5-6 and â‰ shall be categorized as having low, moderate and high burnout for each level respectively, while the radiographers having mean values of personal accomplishment â‰, 39-32 and â‰¤ 33 shall be categorized as having low, moderate and high levels of burnout for the 3 stages, respectively.

Assessing Predictors of Burnout

In this study, they stated that job satisfaction is a factor that helps to predict burnout among nurses. This agreed with the present study where satisfaction correlated strongly and negatively with emotional exhaustion (r=-0.07) and positively with personal accomplishment (r=0.35). From this study, job satisfaction is one of the predictors of burnout. Increased job satisfaction will reduce emotional exhaustion at work and improve personal accomplishment among radiographers. The result of this study showed that job satisfaction â‰¤ 5 could predispose radiographers to burnout, since it is less than the cut off value for job satisfaction. In this study by Akroyd et al. [3], they noted that workload is a factor that can help predict burnout. This also agreed with the present study where number of cases done per day (workload) correlated significantly and positively with burnout (r=0.47). The findings demonstrated that as the number of cases above the mean value of 24 increases, burnout also increases. The study also showed that a number case per day could be a major factor that predisposed Nigerian radiographers to burnout. This shows that at mean value of 24 for number of cases done per day, radiographers are predisposed to high level of burnout. The result of this study showed that radiographers who are predisposed to burnout in this study would have got atleast 5 years of working experience, since mean years of working experience for the subjects in the sample was 5.

Content Analysis of Comments made by Radiographers

The analysis of comment made by radiographers indicates that a greater percentage of radiographers believe that employing more radiographers is the best way of reducing burnout among radiographers. Radiographers further noted that the use of ultra modern equipments with ergonomic facilities is another effective means of reducing burnout. Radiographers also suggested that providing good and conducive environment can help alleviate burnout. Few radiographers suggested the need for RRBN to organize burnout reduction workshops, while the least comment was that of booking cases. Contend that current work environment contributes to occupational burnout.

Summary of Findings

Findings revealed that radiographers have high levels of the first stage of burnout (emotional exhaustion), lower levels of the second level of burnout (depersonalization), and moderate level of the third stage of burnout ( personal accomplishment). These burn-out levels differed with age, sex, cadre and job descriptions. Also in the study, there is a significant and higher level of burnout experienced by Nigerian radiographers more than the standard Maslach burnout inventory norm, hence necessitating the creation of proposed national norms of burnout for radiographers in Nigeria.

Radiographers exhibited higher level of emotional exhaustion, lower level of depersonalization and higher level of personal accomplishment. Therefore, health care organisations need to acknowledge that those who work in the helping profession like radiography may need to cope with stress and burnout that is often associated with such practice. Reduced burnout among radiographers would lead to increased quality of patient care, improved quality of life, higher levels of job satisfactions and commitment, improved work environment and high staff strength.

From an organizational perspective, high levels of employee stress and associated burnout can lead to absenteeism, reduced productivity, medical expenses and even large expenditure by the Nigerian health sector.

Interventions can be introduced at various levels namely individual,Â individual/organizational interface and organisational intervention. Such strategies must focus on increasing awareness, adopting coping skills through time management and better training opportunities. Emotional support at work, the work environment, coaching and counseling are further ways of reducing burn-out. Radiographersâ€™ Registration Board of Nigeria (RRBN)/ Association of radiographers of Nigeria (ARN) should organize conferences and symposia on stress, and burnout management in order to help radiographers gain useful knowledge and improve on their stress/burnout management skills. Therefore, burnout workshop is an indispensable programme in the quest to reduce burnout. The hospital management should also provide a relaxation centre in case the staff is stressed up for relaxation purposes.

The major limitation of this study is the fact that only a geopolitical zone of Nigeria was involved, and thus, caution may apply in generalizing its findings.

References

Freudenberger BE (1974) Staff Burnout. J Environ Issues 30: 159-165.

Gillespie DF (1991)

Akroyd D, Caison A, Adams R (2002)