Burnout Syndrome in Paediatric Nurses: A Multi-Centre Study

In e na ional Jou nal o En i onmen al Resea ch and Public Heal h A icle Bu nou Synd ome in Paedia ic Nu ses: A Mul i-Cen e S udy Emilia I. De la Fuen e-Solana 1, Lau a P adas-He nández 2,*, Ca men Tama a González-Fe nández 3, Almudena Velando-So iano 3, Ma ía Begoña Ma os-Cab e a 2, JoséL. Gómez-U quiza 4 and Guille mo A u o Cañadas-De la Fuen e 4   Ci a ion: De la Fuen e-Solana, E.I.; P adas-He nández, L.; González-Fe nández, C.T.; Velando-So iano, A.; Ma os-Cab e a, M.B.; Gómez-U quiza, J.L.; Cañadas-De la Fuen e, G.A. Bu nou Synd ome in Paedia ic Nu ses: A Mul i-Cen e S udy. In . J. En i on. Res. Public Heal h 2021,18, 1324. h ps://doi.o g/10.3390/ije ph 18031324 Academic Edi o : Paul B. Tchounwou Recei ed: 21 Decembe 2020 Accep ed: 27 Janua y 2021 Published: 1 Feb ua y 2021 Publishe ’s No e: MDPI s ays neu al wi h ega d o ju isdic ional claims in published maps and ins i u ional a il- ia ions. Copy igh : © 2021 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). 1B ain, Mind and Beha io Resea ch Cen e (CIMCYC), Campus Uni e si a io de Ca uja s/n, Uni e si y o G anada, 18071 G anada, Spain; ed uen e@ug .es 2San Cecilio Clinical Uni e si y Hospi al, Andalusian Heal h Se ice, A enida de la In es igación s/n, 18016 G anada, Spain; [email p o ec ed] 3 Vi gen de las Nie es Uni e si y Hospi al, Andalusian Heal h Se ice, A enida de las Fue zas A madas, n º 6, 18014 G anada, Spain; [email p o ec ed] (C.T.G.-F.); [email p o ec ed] (A.V.-S.) 4Facul y o Heal h Sciences, Uni e si y o G anada, A enida de la Ilus ación 60, 18016 G anada, Spain; jlgu quiza@ug .es (J.L.G.-U.); gac @ug .es (G.A.C.-D.l.F.) *Co espondence: [email p o ec ed] Abs ac : Backg ound: Bu nou synd ome is an inc easingly p e alen p oblem, cha ac e ised by emo ional exhaus ion (EE), depe sonaliza ion (D), and low pe sonal accomplishmen (PA), eelings ha appea wi h p olonged exposu e o s ess-inducing si ua ions. The synd ome al e s physical well-being and endange s he quali y o se ices p o ided. Among nu ses wo king in he paedia ic a ea, he associa ion be ween bu nou and he co esponding isk p o ile has ecei ed li le esea ch a en ion, despi e he highly s ess ul na u e o his wo k. Ma e ials and Me hods: The s udy popula- ion was composed o 95 nu ses wo king in ou hospi als in he p o ince o G anada. Da a we e collec ed using he Maslach Bu nou In en o y, he NEO Pe sonali y In en o y, and he Educa ional- Clinical Ques ionnai e: Anxie y and Dep ession. Resul s: Acco ding o he esul s ob ained, 22.0% o he nu ses wo king in he paedia ic a ea p esen high le els o EE, 18.5% p esen high le els o D, and 39.6% had eelings o low PA. These bu nou le els do no depend on sociodemog aphic o labou a iables, bu he h ee domains o he synd ome a e ela ed o he psychological ac o s analysed. Conclusions: Among he nu ses who pa icipa ed in his s udy, 38.6% p esen ed high le els o bu nou , especially ega ding eelings o low pe sonal accomplishmen . Pe sonali y ac o s play an impo an ole in he de elopmen o his synd ome. This s udy shows he impac o bu nou in paedia ic nu ses as well as he isk ac o s, p o iding in o ma ion o he de elopmen o s a egies o p e en i . Keywo ds: bu nou ; nu sing; paedia ics; pe sonali y ac o s; p e en ion 1. In oduc ion Bu nou synd ome is an inc easingly p e alen p oblem. One sec o o he wo king popula ion whe e bu nou is pa icula ly acu e is ha o heal hca e p o essionals, among which nu ses a e especially ulne able [1]. Bu nou a ises om cons an exposu e o p essu e in he wo kplace, which p o okes a nega i e impac bo h on he pe sons a ec ed and on hei en i onmen [ 2 ]. Many de ini ions o bu nou ha e been p oposed, bu one o he mos widely accep ed is ha o Maslach and Jackson (1981), who desc ibed bu nou as a psychological synd ome ha a ises in esponse o ch onic s esso s, and is cha ac e ized by h ee dimensions—emo ional exhaus ion (EE), depe sonaliza ion (D), and low pe sonal accomplishmen (PA). Mo eo e , his ini ial iew emphasized ha bu nou a ec ed indi iduals whose wo k in ol ed in e ac ion wi h o he s [1,3–5]. On his concep ual basis, he abo e-men ioned au ho s c ea ed he Maslach Bu nou In en o y (MBI), which measu ed he same h ee domains and was in ended o quan i y In . J. En i on. Res. Public Heal h 2021,18, 1324. h ps://doi.o g/10.3390/ije ph18031324 h ps://www.mdpi.com/jou nal/ije ph In . J. En i on. Res. Public Heal h 2021,18, 1324 2 o 10 he deg ee o bu nou su e ed—low, medium, o high [ 6 ]. Al hough o he alida ed scales wi h he same objec i e ha e been sugges ed, and mul iple adap a ions ha e been made o di e en popula ion g oups [ 7 – 9 ], he MBI is s ill one o he mos commonly used [ 10 ]. Bu nou is conside ed an occupa ional disease. I can p oduce mul iple psychological p oblems, such as anxie y and dep ession, leading hose a ec ed o abandon he p o es- sion [ 2 ], hus ha ing nega i e consequences bo h o nu ses and o he wo k en i onmen . Nu ses a e especially exposed o he dange o bu nou , as hey mus o en wo k in ad e se condi ions wi h ew esou ces [ 11 ]. Mo eo e , i nu ses su e om bu nou , he ca e p o ided will also su e , in e ms o p oduc i i y and heal hca e quali y, o he de imen o pa ien s [12]. Among he nu sing communi y, hose employed in he paedia ic a ea, ca ing o pa- ien s aged 0–15 yea s, a e a g ea isk o de eloping signi ican le els o bu nou , because o he wo king condi ions implici in hei p o ession, which impose bo h physical and emo ional demands [ 13 – 16 ]. S udies ha e shown ha in he Andalusian Heal h Se ice (SAS), he p e alence o bu nou is ex eme in a ious hospi al se ices, including he med- ical depa men [ 17 ], oncology [ 18 ], c i ical ca e [ 19 ], and p ima y ca e [ 20 ]. Ne e heless, o ou knowledge, no esea ch in o ma ion has been published conce ning bu nou among paedia ic nu ses. In iew o hese conside a ions, he p esen s udy has he ollowing aims: o de e mine he p e alence and le els o bu nou expe ienced by nu ses in he paedia ic a ea o SAS hospi als; o iden i y he deg ee o bu nou among paedia ic nu ses, acco ding o he model p oposed by Golembiewski; and o desc ibe he ela ionship be ween bu nou and he ele an sociodemog aphic, occupa ional, and pe sonali y ac o s. 2. Ma e ials and Me hods 2.1. Sample In his c oss-sec ional mul icen e s udy, he sample popula ion consis ed o 95 nu ses wo king in he paedia ic uni s o ou high-le el public hospi als in he p o ince o G anada (Spain), o ming pa o he Andalusian Heal h Se ice. S udy da a we e collec ed using non- andom o con enience sampling by quo as. In his p ocedu e, ques ionnai es we e dis ibu ed in sealed en elopes o he a ge popula ion. O he 130 dis ibu ed, 98 we e e u ned, o which 95 we e comple e and sui able o analysis. 2.2. S udy Design and Da a Collec ion Da a o his s udy we e collec ed wi h he collabo a ion o he nu sing managemen and he se ice supe iso s o each hospi al. The hospi als we e gi en he necessa y in o ma ion and he equisi e pe missions we e ob ained. The nu ses ecei ed de ailed documen a ion abou he s udy, and ga e signed in o med consen o pa icipa e. Pa icipa- ion was olun a y, indi idual, and anonymous. The es ima ed ime equi ed o comple e he ques ionnai e was 45 min. Collec ion o he s udy da a began in Oc obe 2019 and concluded in Feb ua y 2020. The ques ionnai e consis ed o se e al pa s. In he i s , he ollowing sociode- mog aphic and occupa ional da a we e ob ained: on he one hand, age (yea s), sex (male/ emale), ma i al s a us (single, ma ied, sepa a ed, di o ced, o widowed) and child en (n); and on he o he , wo k shi ( o a ing/ ixed), on-call obliga ion (yes/no), and nu sing expe ience (mon hs). The Re ised NEO Pe sonali y In en o y [ 21 ] (NEO-FFI), Spanish-language e sion [ 22 ], was applied. This ins umen measu es he i e majo pe sonali y ai s—neu o icism, ex a e sion, conscien iousness, ag eeableness, and openness. Ou s udy used a sho e e sion o he in en o y, wi h 60 i ems, 12 o each domain, sco ed on a i e-poin Like scale. As a esul o copy igh , he ull ques ionnai e is no p esen ed in his pape . The ollowing in e nal consis ency coe icien s we e ob ained: neu o icism ( α = 0.729), ex a e - sion ( α = 0.737), conscien iousness ( α = 0.84), ag eeableness ( α = 0.629), and openness ( α = 0.715). C onbach’s alpha ( α ) is used o assessing he eliabili y o a ques ionnai e In . J. En i on. Res. Public Heal h 2021,18, 1324 3 o 10 (in e nal consis ency). I mus be calcula ed in he s udy sample in o de o e i y ha he eliabili y o he o iginal ques ionnai e is main ained. In addi ion, he Educa ional-Clinical Ques ionnai e: Anxie y and Dep ession (CECAD) [ 23 ] was used o measu e symp oms o anxie y and dep ession, in acco dance wi h he Diag- nos ic and S a is ical Manual o Men al Diso de s (DSM-V). This ins umen consis s o 45 i ems sco ed on a i e-poin Like scale, wi h 19 i ems o anxie y and 26 o dep ession. The in e nal consis ency coe icien s ob ained we e α = 0.934 o anxie y and α = 0.954 o dep ession. The h ee domains o bu nou we e measu ed using he Maslach Bu nou In en o y- Human Se ice Su ey (MBI-HSS) [ 6 ], in he Spanish-language e sion [ 9 ], which consis s o 22 i ems, sco ed on a se en-poin Like scale. This ques ionnai e con ains nine i ems on EE, i e on D, and eigh on PA. The cu -o poin s (es ablished by he au ho s and included in he MBI manual) a which each domain was conside ed o ep esen a high le el o bu nou we e >24 o EE, >9 o D, and <33 o PA. A low le el o EE is <15 poin s and <4 poin s o D. A medium le el o EE is be ween 15–24 poin s and be ween 4–9 o D. A medium PA is be ween 33–39 poin s and high PA is > han 39. The in e nal consis ency coe icien s ob ained we e α= 0.861 o EE, α= 0.628 o D, and α= 0.758 o PA [20]. Finally, he o e all le el o bu nou was ob ained acco ding o he p ocess desc ibed by Golembiewski and Munzen ide [ 24 ], and he sco e o each bu nou domain was classi ied as low o high, ia eigh phases. Subjec s wi h low o high bu nou in he h ee dimensions ob ain a low o high bu nou phase classi ica ion, espec i ely. Medium phases a e he esul o combining di e en le els in he dimensions, s a ing wi h an inc ease in D and la e in low PA and EE. Wi h his da a, Golembiewski e al. ob ained signi ican di e ences o concluding ha phases 1 and 2 a e low bu nou ; phases 3, 4, and 5 a e mode a e bu nou ; and 6, 7, and 8 a e high bu nou [24]. 2.3. S a is ical Analysis The ollowing desc ip i e s a is ics we e ob ained o he quan i a i e a iables: mean, s anda d de ia ion, and maximum and minimum alues. Fo he quali a i e a iables, pe cen ages and equencies we e ob ained. The quan i a i e a iables (EE, D, and PA) in ela ion o he quali a i e a iables conside ed, and we e compa ed using S uden ’s - es . Pea son’s co ela ion coe icien was used o de e mine he linea ela ionships be ween he quan i a i e a iables. Finally, a mul iple linea eg ession analysis was pe o med o each o he MBI domains. All o he analyses we e pe o med using SPSS 25.0 s a is ical so wa e (IBM, A monk, NY, USA). 2.4. E hical Conside a ions In all cases, pa icipa ion in his s udy was olun a y, anonymous, and conduc ed in acco dance wi h he e hical guidelines o he Decla a ion o Helsinki. In addi ion, he s udy was app o ed by he G anada P o incial Resea ch E hics Commi ee (TSS-SD-2019). 3. Resul s 3.1. Demog aphic P o ile The s udy sample was composed o 95 nu ses wo king in paedia ic depa men s. By sex, 78.7% we e emale and 21.3% we e male. On a e age, he pa icipan s we e 43.89 yea s old, and had been wo king in he paedia ic a ea o 156.92 mon hs and o e all as nu ses o 254.97 mon hs. Tables 1and 2show he desc ip i e a iables o he sample and he mean sco es ob ained o he h ee domains o bu nou (EE, D, and PA), he i e dimensions o pe son- ali y (neu o icism, ex a e sion, conscien iousness, ag eeableness, and openness), and he pa ame e s o anxie y and dep ession. In . J. En i on. Res. Public Heal h 2021,18, 1324 4 o 10 Table 1. Desc ip i e da a and quali a i e a iables. Va iable % (n) Sex Male 23.2 (22) Female 76.8 (73) Ma i al s a us Single 30.5 (29) Ma ied 62 (59) Sepa a ed 5.3 (5) Di o ced 1.1 (1) Widowed 1.1 (1) Child en None 27.7 (26) One 18.1 (17) Two 40.4 (38) Th ee o mo e 13.8 (13) Wo k shi Fixed-mo ning 17.9 (17) Fixed-a e noon/e ening 2.1 (2) Fixed-nigh 2.1 (2) Ro a ing 77.9 (74) On-call Yes 33 (30) No 67 (61) Table 2. Desc ip i e da a and quan i a i e a iables. Va iable Mean (SD) Minimum– Maximum Age, yea s (n = 94) 43.89 (10.500) 22–61 Expe ience in paedia ics, mon hs (n = 95) 156.92 (135.004) 1–432 Expe ience in p o ession, mon hs (n = 95) 254.97 (129.976) 2–480 NEO-FFI Neu o icism (n = 94) 27.98 (6.849) 1–48 Ex a e sion (n = 95) 42.51 (6.240) 29–58 Openness (n = 94) 38.07 (6.539) 25–55 Ag eeableness (n = 94) 46.53 (5.045) 34–60 Conscien iousness (n = 94) 47.36 (6.007) 33–59 CECAD Anxie y (n = 93) 35.69 (11.860) 19–89 Dep ession (n = 92) 50.02 (16.686) 26–116 MBI EE (n = 91) 16.37 (10.651) 0–47 D (n = 92) 5.15 (4.806) 0–21 PA (n = 91) 35.93 (7.376) 14–48 3.2. Le els and P e alence o Bu nou To de e mine he le els o bu nou , he sco e ob ained in each domain was ca ego ised as low, medium, o high, in acco dance wi h he cu -o poin s p oposed in he Spanish- language e sion o he MBI [20]. The applica ion o his me hod p oduced he ollowing esul s: in EE, 46.2% o he pa icipa ing nu ses p esen ed a low le el o bu nou , 31.8% a mode a e le el, and 22.0% a high le el. In D, 50.0% p esen ed a low le el, 31.5% a mode a e le el, and 18.5% a high le el. Finally, in PA, 39.6% p esen ed a low le el, 31.8% a mode a e le el, and 28.6% a high le el. Table 3shows he in o ma ion abou bu nou le els. Table 3. Ca ego isa ion o le els o bu nou by domain. Bu nou Le el EE % (n) D % (n) PA % (n) Low 46.2 (42) 50.0 (46) 39.6 (36) Mode a e 31.8 (29) 31.5 (29) 31.8 (29) High 22.0 (20) 18.5 (17) 28.6 (26) In . J. En i on. Res. Public Heal h 2021,18, 1324 5 o 10 3.3. Phases o Bu nou Synd ome The Golembiewski model [ 24 ] was used o classi y he pa icipan s by phases, acco d- ing o he le el o bu nou p esen ed. Phases I, II, and III ep esen low le els o bu nou ; phases IV and V, medium le els; and phases VI, VII and VIII, high le els. In summa y, 38.6% o he nu ses who ook pa in his s udy p esen ed high le els o bu nou (Table 4). Table 4. P e alence o bu nou by phases acco ding o he Golembiewski model. Phase I II III IV V VI VII VIII EE L L L L H H H H DLHLHLHLH PA L L H H L L H H N9 7 29 5 4 15 11 8 (%) 10.2 8.0 33.0 5.7 4.5 17.0 12.5 9.1 EE—emo ional exhaus ion; D—depe sonalisa ion; PA—pe sonal accomplishmen ; H—high; L—low. 3.4. Rela ionship be ween Bu nou and Sociodemog aphic and Occupa ional Fac o s The mean alues o each MBI domain we e compa ed by e e encing he sociodemo- g aphic and occupa ional a iables conside ed (sex, ma i al s a us, numbe o child en, wo k shi , and on-call obliga ion). In hese espec s, no signi ican di e ences we e ob- se ed. Simila ly, no signi ican ela ionships we e ob ained be ween occupa ional ac o s (age and expe ience in he paedia ic a ea and in he nu sing p o ession) and bu nou . 3.5. Rela ionship be ween Bu nou and Psychological Fac o s: Explana o y Models A linea co ela ion was obse ed be ween he MBI domains, hose o he NEO-FFI, and he CECAD anxie y and dep ession sco es. The EE and D domains p esen ed s a is ically signi ican co ela ions wi h anxie y and dep ession, as well as wi h he pe sonali y ac o s, excep ha o openness. PA was signi ican ly co ela ed wi h dep ession, bu no wi h anxie y. All o he domains, including openness, p esen ed a s a is ically signi ican co ela ion (Table 5). Table 5. Coe icien o co ela ion be ween psychological a iables and bu nou . EE D PA NEO-FFI Neu o icism 0.610 ** 0.372 ** −0.285 ** Ex a e sion −0.407 ** −0.351 ** 0.422 ** Conscien iousness −0.318 ** −0.441 ** 0.497 ** Ag eeableness −0.276 ** −0.439 ** 0.269 * Openness −0.149 −0.132 0.280 ** CECAD Dep ession 0.637 ** 0.409 ** −0.236 * Anxie y 0.572 ** 0.292 ** −0.153 EE—emo ional exhaus ion; D—depe sonalisa ion; PA—pe sonal accomplishmen ; * = p< 0.001; ** = p< 0.005. A mul iple linea eg ession model was ob ained o each o he bu nou domains. The model explains 46.7% o he a iabili y o EE ( 2 = 0.467), o which bo h dep ession (B = 0.264; p= 0.000) and neu o icism (B = 0.547; p= 0.001) we e s a is ically signi ican p edic o s. The goodness o i alue o D was 2 = 0.324. The a iables ha we e s a is ically signi ican p edic o s o his domain we e dep ession (B = 0.067; p= 0.021), conscien iousness (b = − 0.188; p= 0.023), and ag eeableness (B = − 0.288; p= 0.002). Finally, o PA, 31% o he a iabili y was explained by he model ( 2 = 0.310). In his case, conscien iousness (B = 0.503; p= 0.000) and ex a e sion (B = 0.337; p= 0.009) we e s a is ically signi ican p edic o s (Table 6). In . J. En i on. Res. Public Heal h 2021,18, 1324 6 o 10 Table 6. Mul iple linea eg ession be ween he bu nou domains, pe sonali y ac o s, anxie y, and dep ession. B S d. E o Be a p EE Dep ession 0.264 0.068 0.404 3.864 0.000 Neu o icism 0.547 0.163 0.350 3.347 0.001 D Dep ession 0.067 0.029 0.231 2.358 0.021 Conscien iousness −0.188 0.081 −0.236 −2.312 0.023 Ag eeableness −0.288 0.091 −0.305 −3.154 0.002 RP Conscien iousness 0.503 0.129 0.391 3.903 0.000 Ex a e sion 0.337 0.126 0.268 2.675 0.009 EE—emo ional exhaus ion; D—depe sonalisa ion; PA—pe sonal accomplishmen ; B—es ima ed pa ame e ; —S uden ’s - es alue. 4. Discussion The esul s ob ained show ha 22.0% o he paedia ic nu ses su eyed p esen ed high le els o EE, 18.5% high le els o D, and 39.6% low le els o PA. These le els o EE and D a e g ea e han hose shown in one s udy wi h nu ses om c i ical ca e uni s [ 19 ], lowe han ano he s udy wi h p ima y ca e nu ses [ 20 ], and also show a highe p e alence o low PA and a lowe p e alence o EE han hose shown in a me a-analysis wi h paedia ic oncology nu ses [16]. These le els show ha a signi ican amoun o paedia ic nu ses a e a ec ed by bu nou , co obo a ing p e ious esea ch indings [ 25 – 27 ], and may be ela ed o he gene ally low le els o job sa is ac ion pe cei ed by hese p o essionals. When his occu s, i no only has nega i e epe cussions on he heal hca e wo ke s hemsel es, bu may also lead hem o eel less empa hy wi h hei pa ien s and/o ail o pe o m hei wo k app op ia ely, esul ing in a dec ease in he quali y o ca e p o ided [ 28 , 29 ]. High le els o bu nou can be in luenced by a ious cha ac e is ics, including ma i al s a us, age, p o essional expe ience, and he bu den o ca e [25]. S udies ha e obse ed a ela ionship be ween bu nou and ce ain sociodemog aphic and occupa ional cha ac e is ics. Some ha e sugges ed ha age is in e sely ela ed o he synd ome, i.e., ha younge nu ses a e mo e likely o expe ience his condi ion [ 30 , 31 ]. O he pape s, howe e , ha e d awn he opposi e conclusion, inding ha olde wo ke s a e mo e likely o pe cei e low le els o PA [ 32 ]. By sex, D has been epo ed o be mo e acu e among male han emale nu ses [ 33 ], and ega ding ma i al s a us, i has been epo ed ha single nu ses ha e lowe le els o PA, which may e lec inadequa e o ms o coping wi h ad e si y o a pe cei ed lack o social suppo [ 34 ]. One s udy ound he leng h o p o essional expe ience o be in e sely ela ed o bu nou ; in o he wo ds, ela i ely inexpe ienced nu ses a e mo e likely o su e om his synd ome [ 30 ]. Howe e , we ound no ela ionship be ween he bu nou domains and he sociodemog aphic a iables conside ed (age, ma i al s a us, and child en) o hose conce ning he wo k en i onmen (senio i y and shi o on-call obliga ion), which is in line wi h some p e ious indings [ 35 ]. We also co obo a e esul s showing ha hese a iables do no appea o signi ican ly in luence le els o bu nou . In o he wo ds, nei he he nu ses’ age, gende , no leng h o expe ience de e mine hei exposu e o bu nou ; his is pa icula ly e iden in high- isk a eas, such as paedia ic oncology [16,36–38]. Rega ding he p e alence o bu nou in paedia ic nu ses, he alues we ob ained o PA, EE, and D we e highe han hose epo ed p e iously [ 39 ]. EE is especially high among nu ses wo king in he oncology a ea, while high D and low PA a e mo e p e alen in paedia ic depa men s [ 40 ]. This con as is mainly due o he ypes o pa ien s ea ed in he di e en depa men s; pa ien s may emain in oncology ea men o ex ended In . J. En i on. Res. Public Heal h 2021,18, 1324 7 o 10 pe iods and he s a become mo e emo ionally in ol ed, a consequence o which can be high le els o EE. When es ablishing isk p o iles o nu ses wo king in he paedia ic a ea, psycho- logical a iables mus be conside ed. Fo example, EE and pe sonali y ac o s a e o en in e ela ed; in ou s udy popula ion, neu o icism was ound o be associa ed wi h g ea e EE, as obse ed p e iously by Ang e al. [ 41 ]. Mo eo e , i is in e sely associa ed wi h ex- a e sion, conscien iousness, ag eeableness, and openness [ 42 ]. I has also been obse ed ha ele a ed le els o EE a e ela ed o g ea e anxie y and dep ession, because o hese nu ses’ daily exposu e o auma ic s esso s in hei wo k en i onmen [43]. Simila ly, D is o en associa ed wi h pe sonali y ac o s. Thus, ou indings e lec a posi i e associa ion wi h neu o icism and a nega i e one wi h ex a e sion, conscien- iousness, ag eeableness, and openness, sugges ing ha p o essionals wi h his ype o pe sonali y ake a close , mo e empa he ic app oach in hei wo k [ 42 , 44 ]. This domain is also posi i ely ela ed o dep ession and anxie y, which implies ha nu ses may eel insecu e ega ding pa ien ca e and he a endan isks. Fo his eason, some p o essionals y no o become closely in ol ed, which in u n a o s D [45]. Finally, an in e se ela ionship was obse ed be ween PA and neu o icism, and a posi i e one wi h he o he pe sonali y ac o s [ 46 ]. Dep ession and anxie y also p esen ed an in e se ela ionship wi h PA. The high le els o PA eco ded among he nu ses in his s udy and he ac ha 38.6% p esen ed high le els o bu nou may be ela ed o ac o s such as emo ional bu den, a ising om close con ac wi h child en and hei amilies; wi h he disease p ocess; and, in some cases, wi h he dea h o he pa ien [ 12 ]. The join impac o hese ac o s, oge he wi h he scan pe sonal and p o essional ecogni ion o en ecei ed, can gene a e a i udes o indi e ence among paedia ic nu ses, and can e en lead hem o conside abandoning he p o ession [ 47 , 48 ]. P e ious s udies in his ield ha e concluded ha low PA is ela ed o a lack o p o essional au onomy [ 49 ], oge he wi h o he ac o s, such as low sala y [50]. In ou s udy, he eg ession models ob ained show ha he pe sonali y a iables, wi h he excep ion o openness, and he le el o dep ession expe ienced, a e signi ican p edic o s o bu nou . These esul s a e in line wi h hose ob ained in s udies o o he medical se ices [ 47 ], ha 22.0% o he paedia ic nu ses su eyed p esen high le els o EE, 18.5% high le els o D, and 39.6% low PA. 4.1. Applica ions in Clinical P ac ice The esul s ob ained in he p esen s udy highligh he impo ance o implemen ing s a egies and in e en ions a an ea ly s age in o de o p o ec wo ke s om bu nou [51,52] , h ough g ea e social suppo o ini ia i es ocused on mind ulness [47,53]. 4.2. Limi a ions This s udy is subjec o ce ain limi a ions. In he i s place, al hough i did include s a om ou di e en hospi als, he s udy sample was no e y la ge, he sampling was in en ional, and nu sed eeling some le el o bu nou migh ha e been mo e p one o pa icipa e. Secondly, al hough a ious pe sonali y a iables we e conside ed, o he s, such as esilience, we e omi ed and could use ully ha e been analysed. Fu he mo e, in u u e wo k in his ield, a en ion should be paid o he ques ion o s ess in heal hca e. I would be con enien o s udy wha o he a iables could be pa o a bu nou isk p o ile. Mo e speci ically, i is o in e es which a iables can educe o p o ec nu ses om bu nou . Finally, al hough he Golembiewski model used is e y use ul as a classi ica ion ool, u he esea ch is needed o de elop me hods based on measu ing physiological pa ame e s, in o de o analyse hem mo e p ecisely and o es ablish a be e basis o diagnosing bu nou synd ome. In . J. En i on. Res. Public Heal h 2021,18, 1324 8 o 10 5. Conclusions Many nu ses wo king in he paedia ic a ea expe ience high le els o bu nou . In his espec , he ques ion o scan pe sonal accomplishmen is he domain mos o en ci ed by hese wo ke s. Among he psychological a iables conside ed, neu o icism and dep ession we e ound o be ela ed o a g ea e ulne abili y o bu nou , while ag eeableness, ex a e sion, conscien iousness, and openness p o ec agains i . In he case o anxie y, i a ec s EE and D, bu no PA le els. The sociodemog aphic and occupa ional ac o s conside ed we e no signi ican ly associa ed wi h he p opensi y o bu nou . These esul s aise he impo ance o c ea ing s a egies and p og ams o p omo ing bu nou p o ec ing ac o s and imp o ing he p oblem o bu nou in his a ea. Au ho Con ibu ions: Concep ualiza ion, G.A.C.-D.l.F., L.P.-H., C.T.G.-F., and E.I.D.l.F.-S.; me hod- ology, E.I.D.l.F.-S.; so wa e, A.V.-S.; alida ion, M.B.M.-C. and J.L.G.-U.; o mal analysis, L.P.-H. and J.L.G.-U.; in es iga ion, L.P.-H.; esou ces, L.P.-H., C.T.G.-F. and M.B.M.-C.; da a cu a ion, L.P.-H. and C.T.G.-F.; w i ing—o iginal d a p epa a ion, L.P.-H. and A.V.-S.; w i ing— e iew and edi ing, L.P.- H. and A.V.-S.; isualiza ion, M.B.M.-C. and G.A.C.-D.l.F.; supe ision, G.A.C.-D.l.F. and E.I.D.l.F.-S.; p ojec adminis a ion, E.I.D.l.F.-S.; unding acquisi ion, E.I.D.l.F.-S. All au ho s ha e ead and ag eed o he published e sion o he manusc ip . Funding: This s udy ecei ed unding om he Jun a de Andalucía Excellence p ojec (no. P11HUM-7771). Ins i u ional Re iew Boa d S a emen : The s udy was app o ed by he G anada P o incial Resea ch E hics Commi ee (TSS-SD-2019). In o med Consen S a emen : In o med consen was ob ained om all subjec s in ol ed in he s udy. 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