International Emergency Nursing 60 (2022) 101114

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International Emergency Nursing

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Psychological immune competency predicts burnout syndrome among the

high-risk healthcare staff: A cross-sectional study
Mona Stankovic a, *, László Papp a, László Ivánkovits a, György Lázár b, Zoltán Pető a,
Annamária Töreki a
a
University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Emergency Medicine, Semmelweis utca 6, 6720 Szeged, Hungary
b
University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Department of Surgery, Semmelweis utca 8, 6720 Szeged, Hungary

A R T I C L E I N F O A B S T R A C T

Keyword: Background: Burnout and psychological immune competency have not been investigated together among em­
Burnout syndrome ployees of high-risk specializations such as emergency medicine, intensive care or surgery.
Emergency care Aim: In this study we aim to examine the prevalence of burnout among high-risk clinical staff and explore
Intensive care
whether the strength of psychological immune competency predict burnout.
Nursing
Design: A cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the
Prevention
Psychological immune competency participants (n = 216). Nurses (n = 145) and physicians (n = 71) from emergency medicine, intensive care and
Surgery surgery departments participated in the study.
Method: Burnout syndrome was measured using the Maslach Burnout Inventory, while psychological immune
competency was measured using the Psychological Immune Competency Questionnaire. The data collection
started in June of 2018 and was finished in March of 2019.
Results: Participants with higher psychological immune competency reported lower levels of burnout: emotional
exhaustion (r = − 0.478; p < 0.001), depersonalization (r = − 0.459; p < 0.001) and personal accomplishment (r
= 0.543; p < 0.001). Multiple linear stepwise regression analysis revealed the psychological immune competency
to be a stable predictor of burnout on all three scales.
Conclusion: Psychological immune competency shows a strong relationship with scales of burnout syndrome and
as such should be further examined due to development of successful intervention and prevention programs.

1. Introduction According to the work of Christina Maslach, burnout syndrome is

defined by three dimensions: emotional exhaustion, depersonalization,
Burnout is a syndrome of emotional, mental and cognitive exhaus­ and a sense of inefficacy, decrease in personal accomplishment [4,5].
tion. It is an important consequence of workplace stress and as such it is Emotional exhaustion is the most important indicator of personal
receiving increased attention [1,2]. The 11th revision of the Interna­ burnout, characterized by depletion of psychological and emotional
tional Classification of Diseases, published in 2019 by the World Health resources, negative attitudes towards work and life, fatigue, loss of en­
Organization, includes burnout syndrome as an occupational phenom­ ergy, resistance to work and feeling of purposelessness [6]. Deperson­
enon in the chapter on factors influencing health status or contact with alization is a social component, defined by cynicism and impersonal
health services. According to the ICD-11, burnout syndrome is a phe­ attitude in relationships with patients associated with negative emo­
nomenon interpretable in the occupational context, which occurs as a tions. Personal accomplishment dimension describes the relationship
result of chronic workplace stress coupled with unsuccessful stress- between a person and their work, one’s assessment of their own work
management. It is characterized by three dimensions: feelings of en­ performance [5,7].
ergy depletion or exhaustion; increased mental distance, feelings of The prevalence of burnout syndrome among the helping professions
negativism or cynicism related to one’s job; and reduced professional (such as teachers or clinical staff) seems to be higher than among other
efficacy [3]. occupations [5,8,9]. The long working hours, delay in positive feedback,

* Corresponding author.
E-mail addresses: [email protected] (M. Stankovic), [email protected] (L. Papp), [email protected] (L. Ivánkovits), lazar.
[email protected] (G. Lázár), [email protected] (Z. Pető), [email protected] (A. Töreki).

https://doi.org/10.1016/j.ienj.2021.101114
Received 18 October 2020; Received in revised form 3 November 2021; Accepted 16 November 2021
Available online 23 December 2021
1755-599X/© 2021 Elsevier Ltd. All rights reserved.
M. Stankovic et al. International Emergency Nursing 60 (2022) 101114

difficulty in maintaining work-life balance, emotionally stressful patient mobilizing capacity, social creating capacity, synchronicity, goal
relationships in a constantly changing healthcare environment all orientation, impulse control, emotional control, irritability control) into
contribute to increased burnout levels among the medical professionals a specific protective apparatus granting a certain immunity when faced
[8,10,11]. The occurrence of burnout syndrome among healthcare with “psychological pathogens” such as stress, trauma or their negative
workers is significantly higher in some specializations, such as surgery, outcomes [14].
emergency medicine, intensive care, traumatology or general physician The psychological immune competency integrates different coping
practice [5,7,10,12]. Stronger psychological immune competency might skills into a multidimensional complex network providing capabilities of
be of paramount importance for clinical professionals working in these successful adaptation, strengthening invulnerability and raising the
fields. The psychological immune competency is an integration of coping capacity of individuals [26,27]. It monitors situations, mobilizes
different coping skills for adequate adaptation and stress-management resources, designs and executes adaptive pathways, furthermore it en­
[13], and it has been previously reported that general practitioners sures the integrated functioning of the personality and facilitates
with higher psychological immune competency show lower levels of development and self-growth. The psychological immune competency
burnout [14]. has been reported to have a strong correlation with well-being and life-
satisfaction dimensions, for example: environmental mastery, purpose
2. Background in life, personal growth, self-acceptance, positive relations, and auton­
omy [28]. Personality’s protective qualities, such as sense of coherence,
In the field of emergency medicine, intensive therapy and surgery the sense of self-growth, synchronicity, impulse control, emotional control,
clinical staff is facing high expectations in terms of professional re­ and irritability control, have a strong relationship with mental and
sponsibilities, however they have only limited control and authority physical health, and those, who have higher levels of immunity on these
over their work. Caring for patients in critical conditions, performing scales show less signs of burnout on all three scales [13,14,28,29]. The
various medical procedures with absolute precision, responding accu­ coping strategies of psychological immune system, such as positive
rately and quickly to extremely urgent situations are all daily tasks for thinking, sense of control, sense of coherence, and sense of self-growth
nurses and physicians in these medical fields [15]. play a mediating role in psychological adjustment and mental health
Such organizational characteristics, in accordance with Robert Kar­ in cases of acute psychopathology [28,30].
asek’s job demand-control model, provide perfect conditions for Even though the Central European region is underrepresented in
burnout [16]. Exhausting pressure and duties coupled with limited burnout research, there have been some studies on burnout syndrome
control over job circumstances present a breeding ground for high levels executed on Hungarian samples [6,31–33], which partially mapped out
of work-related stress. For healthcare professionals in the above- the occurrence, background factors and risk factors of burnout syndrome
mentioned fields the excessive workload [17,18], the time pressure among general practitioners, medical students or female physicians
and task complexity, the intensive use of sophisticated technology all [7,31,34]. These studies confirm the relationship between work stress,
contribute to work-related stress, while the level of control and au­ physical and emotional burden and burnout, and define the emotional
thority (development of new skillsets, influence over workflows, exhaustion, depersonalization, depletion of performance, poor rela­
decision-making power) in many cases stays low [15,16,18]. In past tionship with colleagues and lack of communication to be key factors
decades burnout research has identified a plethora of organizational risk contributing to higher levels of burnout [6,31–33]. There is so far no
factors, which are represented in six domains, namely: workload, con­ data on relationship between the psychological immune competency
trol, reward, fairness, community and values [18,19]. First two areas are and burnout syndrome among employees of emergency departments,
reflected in the previously discussed demand-control model of job stress. intensive care units or surgery departments, which is particularly
Insufficient recognition and reward devalue the work and the workers important, as these healthcare professionals are working in high-stress
and is closely associated with feelings of inefficacy. Fairness is the extent environments.
to which decisions at work are perceived as being fair and equitable, Aim: The aim of this study is to assess the prevalence of burnout
while the area of community has to do with the quality of workplace syndrome among critical care professionals in three organizations of
relationships. Finally, the area of values is the alignment of personal and University Hospital and to understand the role psychological immunity
organizational values, ideals and motivations that originally attracted plays in development of burnout. This is the first study in Hungary, to
people to their job [18,19]. Among healthcare professionals working in our knowledge, targeting these high-risk specializations.
critical care several organizational risk factors have been identified,
such as excessive workload and job strain [20], lack of manager support 3. Methods
[21,22], work-life and effort-reward imbalance [23] or burdensome
working conditions for instance understaffing [24] or shift work [25] all 3.1. Participants
of which increase workplace stress and contribute to demoralization and
development of burnout. A sample of the working age population was recruited from three
In present study we attempt to understand how personality traits, different organizations: Department of Emergency Medicine, Depart­
specifically the strength of psychological immune competency affect ment of Surgery and Department of Anaesthesiology and Intensive Care
burnout, while acknowledging that there are several organizational and at the University of Szeged, Hungary. In each organization the distri­
situational factors that have not been the focus of this research. In order bution of the questionnaires was organized by one contact person, who
to better understand the interactional nature of coping mechanisms was previously trained in providing clear and comprehensive verbal
manifesting during successful adaptation, Oláh has conceptualized and instructions to the participants. Participants were informed verbally and
operationalized the construct of psychological immune system as a pool in writing, that participation in the study is voluntary and anonym. The
of psychological adaptive resources providing protection against the ill questionnaires and the statements of consent were separate documents
effects of stress [13]. The psychological immune competency in­ and were collected independently from one another, so the anonymity
corporates coping strategies, protective personality resources, and di­ stayed guarded. A total of 400 questionnaires were distributed, and 222
mensions of resilience such as control capacity, learned resourcefulness, were returned by the specified deadline, amounting to a response rate of
constructive thinking, hardiness, dispositional optimism, ego resiliency, 56%. 6 participants were excluded due to incomplete burnout inventory.
and emotional intelligence. It combines 16 protective personality traits The final sample consisted of 216 physicians and nurses.
(namely, positive thinking, sense of control, sense of coherence, creative
self-concept, sense of self-growth, challenge orientation, social moni­
toring capacity, problem-solving capacity, self-efficacy, social

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M. Stankovic et al. International Emergency Nursing 60 (2022) 101114

3.2. Data collection 14–32), on depersonalization scale 6 points (IQR = 2–12), while on
personal accomplishment scale 38 points (IQR = 44–31). All three re­
Data was collected using a test battery consisting of socio- sults fall into moderate category. Doctors (n = 71) show higher levels of
demographic questions, Maslach Burnout Inventory and Psychological emotional exhaustion (Mdn = 25.5; IQR = 16–35), higher depersonal­
Immune Competency Questionnaire. Burnout syndrome was measured ization (Mdn = 9; IQR = 4–13), and no difference in decline in personal
by the 22-item Hungarian version of the Maslach Burnout Inventory accomplishment (Mdn = 38; IQR = 44–33.75) compared to nurses (n =
[9,35]. When evaluating the Maslach Burnout Inventory, higher scores 145) who report lower levels of emotional exhaustion (Mdn = 22; IQR =
on the emotional exhaustion and depersonalization scales indicate a 13–30) and depersonalization (Mdn = 5; IQR = 2–11) and average
stronger burnout level, whereas the personal accomplishment scale is to decline (Mdn = 38; IQR = 43–30) on personal accomplishment scale.
be interpreted in the opposite direction, so a lower score means higher The difference in emotional exhaustion (p = 0.046) and depersonal­
burnout [36]. The Psychological Immune Competency Questionnaire ization (p = 0.007) results reached by the doctors and nurses is statis­
was used to assess the psychological immunity, an 80-item, 16-factor tically significant, while the difference in personal accomplishment (p =
(positive thinking, sense of control, sense of coherence, creative self- 0.255) is not (Table 1).
concept, sense of self-growth, challenge orientation, social monitoring Results of Kruskal-Wallis test found significant differences between
capacity, problem-solving capacity, self-efficacy, social mobilizing ca­ the three departments in all cases: emotional exhaustion (p = 0.018),
pacity, social creating capacity, synchronicity, goal orientation, impulse depersonalization (p = 0.001), personal accomplishment (p = 0.001).
control, emotional control, irritability control) inquiry [13]. The re­
sponses are made on a 4-point scale ranging from (1) completely does 4.3. Burnout and psychological immune competency
not describe me to (4) completely describes me. The higher the scores
the stronger and more active the psychological immune system when Comparing the strength of psychological immune system between
confronting stress. The Cronbach Alpha ranged from 0.62 to 0.80 and subjects who are at least moderately burnt out on at least one of the
the retest reliability ranged from 0.77 to 0.89 for all the sixteen scales. scales to their colleagues who are not, we find the difference to be sig­
The test battery took approximately 15–20 min to complete and was nificant (MW U test, p < 0.001). The correlation between the scores
completed in paper form during work time. The data collection started reached on the Maslach Burnout Inventory and the total value of psy­
in June of 2018 and was finished in March of 2019. chological immune system is significant on the scale of emotional
The study was conducted with the permission of the Regional Med­ exhaustion (r = − 0.478; p < 0.001), depersonalization (r = − 0.459; p <
ical and Research Ethics Committee of the University of Szeged 0.001) and personal accomplishment (r = 0.543; p < 0.001).
(approval No.: 237/2018-SZTE). The scales of the psychological immune competency almost in all
cases correlate with all three scales of burnout (Table 2).
3.3. Data analysis Between the three subsamples we found significant difference in
results on the following scales: Positive Thinking (KW test, p = 0.024),
Since the data was not normally distributed we examined the dif­ Sense of Self-Growth (KW test, p = 0.01), Synchronicity (KW test, p =
ferences in means using Kruskal-Wallis test (KW test) and Mann- 0.01), Impulse Control (KW test, p = 0.021) and Emotional Control (KW
Whitney U test (MW U test). Spearman correlation, was used to map test, p = 0.5). In all cases the lowest scores on these scales were recorded
out the relationship between the scales of burnout (emotional exhaus­ at the Department of Anaesthesiology and Intensive Therapy, who also
tion, depersonalization, personal accomplishment) and the psychologi­ presented with the highest scores of burnout (Table 3).
cal immune system. Multiple stepwise linear regression analysis was
conducted to explore the factors affecting the scales of burnout. Statis­ 4.4. Factors for predicting the level of burnout
tical analysis was performed with the SPSS 23.0 (IBM Corporation,
USA), and significance level was defined at p < 0.05. In order to identify which significant variables predict the levels of
burnout, multiple regression was employed. Five variables (age, number
4. Results of children, level of education, marital status and strength of psycho­
logical immune competency) were entered into the regression equation
4.1. Sample using the stepwise solution. The best predictor of emotional exhaustion
is psychological immune competency, followed by the level of education
In total, 65 employees of the Department of Emergency Medicine and the number of children (adjusted R2 = 0.341). The best predictor of
(DEM), 71 of the Department of Surgery (DS) and 80 of the Department depersonalization (adjusted R2 = 0.312) is also the strength of psycho­
of Anaesthesiology and Intensive Therapy (DAIT) took part in the sur­ logical immune competency, followed by the number of children and
vey. The sample consisted of 71 doctors and 145 nurses. The participants level of education, while the personal accomplishment (adjusted R2 =
were between 23 and 69 years of age, (Mdn = 40; IQR = 31–48). 26% of 0.347) is best predicted by the strength of psychological immune com­
the sample was male (n = 57), while 73% of participants (n = 157) were petency and age (Table 4). Marital status was not a significant predictor
female. of burnout in any case.
63% of the participants are in a relationship, while 36% are single,
divorced or widowed. 34% of the participants have university degree, 5. Discussion
18% have advanced qualifications, 17% have high-school education,
while 16% have a diploma from a vocational school. 43% of the par­ The prevalence of burnout in current study is higher, than previously
ticipants don’t have children, while 57% have children ranging from one reported in general sample of the Hungarian healthcare professionals
child to five. [32]. Participants exhibit moderate burnout on all three scales, although
the depersonalization results seem to be on the border between mod­
4.2. Burnout results erate and low. Similarly, moderate burnout has been reported among
Croatian and Romanian ICU colleagues [1,37]. Even though previous
78% of the sample shows at least moderate burnout on at least one of findings suggest some variables which may influence the level of
the three scales. 66% of the sample shows at least moderate emotional burnout like improvements in working conditions, better work-life
exhaustion, 47% moderate depersonalization, while 50% of participants balance [32], higher levels of autonomy or more focus on quality re­
admit to at least moderate decline in personal accomplishment. lationships [22], the exact nature of the connection between all these
The median on emotional exhaustion scale was 23 points (IQR = factors and burnout remain unclear without comparative studies.

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M. Stankovic et al. International Emergency Nursing 60 (2022) 101114

Table 1
Summary of Burnout results.
Median and IQR Doctors Nurses DEM DS DAIT

Burnout Emotional exhaustion Mdn = 23 IQR = Mdn = 25.5 IQR = Mdn = 22 IQR = Mdn = 21 IQR = Mdn = 20 IQR = Mdn = 26 IQR =
14–32 16–35 13–30 13–31 11.5–28 16–35.75
MW U test p = 0.046* KW test p = 0,018*
Depersonalization Mdn = 6 IQR = Mdn = 9 IQR = 4–13 Mdn = 5 IQR = Mdn = 7 IQR = Mdn = 4 IQR = Mdn = 8 IQR = 4–14
2–12 2–11 3–13 1.75–7
MW U test p = 0.007** KW test p = 0.001**
Personal Mdn = 38 IQR = Mdn = 38 IQR = Mdn = 38 IQR = Mdn = 37 IQR = Mdn = 42.5 IQR = Mdn = 36.5 IQR =
accomplishment 44–31 44–33.75 43–30 42–31 45–34 42–28.25
MW U test p = 0.255 KW test p = 0.001**

Note: **p < 0,01; *0,01 < p < 0,5; t: 0,05 < p < 0,1.

Table 2 Table 3
Correlations between the scales of psychological immune competency and Comparison of data for designated scales of psychological immunity in three
burnout. organizations.
Emotional Depersonalization Personal DEM DS DAIT
exhaustion accomplishment
Positive Thinking Median = 16 Median = 16 Median = 14
Positive Thinking r = − 0.425 r = − 0.394 r = 0.449 IQR = 13–19 IQR = 13–18 IQR = 13–16.75
p < 0.001** p < 0.001** p = 0.001** KW test p = 0.024*
Sense of Control r = − 0.118 r = − 0.213 r = 0.320 Sense of Self-Growth Median = 17 Median = 17 Median = 16
p = 0.086 t p = 0.002** p = 0.001** IQR = 15–19 IQR = 15–18 IQR = 13–18
Sense of Coherence r = − 0.396 r = − 0.402 r = 0.465 KW test p = 0. 010**
p < 0.001** p < 0.001** p = 0.001** Synchronicity Median = 16 Median = 16 Median = 15
Creative Self r = − 0.524 r = − 0.464 r = 0.492 IQR = 14–18 IQR = 13–18 IQR = 12–17
Concept p < 0.001** p < 0.001** p = 0.001** KW test p = 0.010**
Sense of Self- r = − 0.524 r = − 0.464 r = 0.492 Impulse Control Median = 15 Median = 15 Median = 14
Growth p < 0.001** p < 0.001** p = 0.001** IQR = 13–17 IQR = 12–17 IQR = 11.25–16
Change Challenge r = − 0.316 r = − 0.275 r = 0.362 KW test p = 0.021*
Orientation p < 0.001** p < 0.001** p = 0.001** Emotional Control Median = 14 Median = 13 Median = 13
Social Monitoring r = 0.017 r = − 0.035 r = 0.207 IQR = 12–16 IQR = 11–15 IQR = 10–16
p = 0.811 p = 0.611 p = 0.002** KW test p = 0.050*
Problem Solving r = − 0.264 r = − 0.292 r = 0.452
p < 0.001** p < 0.001** p < 0.001** Note: **p < 0,01; *0,01 < p < 0,5; t: 0,05 < p < 0,1.
Self-Efficacy r = − 0.331 r = − 0.404 r = 0.464
p < 0.001** p < 0.001** p < 0.001** Surgery departments are more traditional inpatient facilities, where the
Social Mobilizing r = − 0.155 r = − 0.102 r = 0.198
patients stay responsive and spend several days on the surgical wards
Capacity p = 0.024* p = 0.137 p = 0.003**
Social Creating r = − 0.294 r = − 0.289 r = 0.482 during the preoperative and the postoperative period. The longer time
Capacity p < 0.001** p < 0.001** p < 0.001** spent together presents an opportunity for the clinical staff to gain
Synchronicity r = − 0.472 r = − 0.447 r = 0.431 genuine insight into the patient and form a more complex relationship.
p < 0.001** p < 0.001** p < 0.001** Further research is needed in order to define the precise influence
Goal Orientation r = − 0.280 r = − 0.388 r = 0.385
p < 0.001** p < 0.001** p < 0.001**
responsiveness of patients has on depersonalization and burnout.
Impulse Control r = − 0.334 r = − 0.273 r = 0.155 Consistent with previous findings, the strength of person’s psycho­
p < 0.001** p < 0.001** p = 0.023* logical immune system is a stable predictor of burnout [29]. In addition
Emotional Control r = − 0.419 r = − 0.359 r = 0.218 to the psychological immune competency, we established that the level
p < 0.001** p < 0.001** p = 0.001**
of education and number of children also predict emotional exhaustion
Irritability Control r = − 0.428 r = − 0.365 r = 0.286
p < 0.001** p < 0.001** p < 0.001** and depersonalization, while age predicts personal accomplishment.
The role of age in predicting the levels of perceived personal accom­
Note: **p < 0,01; *0,01 < p < 0,5; t: 0,05 < p < 0,1.
plishment could be supported by the theory, that healthcare workers
develop skills and gain professional confidence over time, as it has been
Physicians report higher scores than nurses on both emotional previously reported that age is a protective factor in burnout
exhaustion and depersonalization scales, while there is no difference in [7,12,39,40]. Clinical employees develop certain coping mechanisms
decline of personal accomplishment between the two groups. The em­ through time that guard them in various stressful situations [7], mean­
ployees of the Department of Anaesthesiology and Intensive Therapy while, workers who are unable to cope with the stressors of the
disclose higher levels of burnout on all three scales, while lowest healthcare system with time leave the profession and retire [41],
depersonalization was recorded at the Department of Surgery. We are explaining why higher levels of burnout are reported among younger
unable to establish direct causation between variables, however ac­ population [12]. Professionals in emergency medicine and critical care
cording to some previous studies [38] one possible reason for high report higher numbers of stressors than general population and more
depersonalization value measured among employees working in emer­ frequent intention to leave [42,43]. Similarly, in some international
gency medicine and intensive care is in connection to the difficulties in findings the number of children has been listed as a protective factor
communication and unresponsiveness of the patients. These pro­ [39,44]. Our data suggests some connection between age, number of
fessionals work in a highly responsible environment, where loss of children and burnout levels as well, but this requires further qualitative
performance is not acceptable, however due to the limited time spent exploration.
with patients and due to the communicational barriers (as a conse­ Psychological immune competency is a construct encapsulating
quence of patients’ critical condition, unconsciousness, intubation or coping strategies, whose strength and diversity predict the success of
cognitive impairment because of shock or high levels or pain) the one’s adaptation. These results support the theory according to which
depersonalization could be a plausible way for burnout to manifest. more adequate coping strategies and a higher degree of resilience

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M. Stankovic et al. International Emergency Nursing 60 (2022) 101114

Table 4
Results of multiple linear stepwise regression analysis.
Block Dependent variable/variable entered Adjusted R2 R square change Standardized coefficient β t p

Emotional exhaustion
1 Psychological immune competency 0.280 0.283 − 0.578 − 9.779 0.000
2 Level of education 0.328 0.051 0.231 − 3.849 0.000
3 Number of children 0.341 0.017 − 0.129 − 2.242 0.024

Depersonalization
1 Psychological immune competency 0.244 0.248 − 0.532 − 8.833 0.000
2 Number of children 0.283 0.043 − 0.202 − 3.427 0.001
3 Level of education 0.312 0.032 0.183 − 3.041 0.003

Personal accomplishment
1 Psychological immune competency 0.325 0.328 0.575 10.063 0.000
2 Age 0.347 0.026 0.161 2.810 0.005

contribute to the proper management of increased work-related stress professionals through experimental or causal data sets, focusing not only
and limit burnout [33,45]. The scales of the psychological immune on personal, but organizational aspects as well. We recommend further
competency all correlated with the scales of burnout, meaning that qualitative research which would enrich the findings of this work by
investing in development of these capabilities would be a reliable point painting a clearer picture of relations between present variables, as well
of intervention when confronting burnout. We identified the scores on as through discovery of new variables, their influence on burnout and
positive thinking, sense of self-growth, synchronicity, impulse control through forming new hypotheses.
and emotional control scales to be significantly lower at the Department Although the used measures were carefully selected and are vali­
of Anaesthesiology and Intensive Therapy, compared to the other two dated as suitable self-report tools, the study is limited by reliance on self-
units. Since the intensive therapy colleagues reached the highest scores reported data, which could have led to bias in responses. Convenience
on burnout scales, further investigation of these coping strategies would sample was used in this study, resulting in findings that may not
be important, in order to clarify whether there is a pattern of strengths necessarily be representative. The generalizability of the findings also
and weaknesses of non-burnt out clinical staff. The sense of self-growth, might be limited, since the sample was selected from only one clinic. We
synchronicity, impulse control and emotional control are all personal­ recommend the inclusion of further healthcare facilities in future
ities protective capabilities, it seems that lacking in these protection research.
skills leaves a person vulnerable to the effects of stress and development We did not focus on organizational and situational components of
of burnout. burnout, but rather individual. Broadening the focus to impacts of
In their work with breast cancer patients, Vargay reports the increase working environment on burnout in the future studies would give a
of psychological immune competency during the active period, when more detailed result.
patients received psychological interventions together with their treat­
ment [28]. This suggests, that psychological immune competency is not 7. Conclusion
a fixed personality trait, but rather that it can be developed and
improved over time. For example, impulse control and emotional con­ This study reveals that 78% of workers of emergency department,
trol functions of psychological immunity both help in managing intensive care unit and department of surgery report at least moderate
momentarily overwhelming emotions and shifting one’s focus toward burnout. The research presents the importance of psychological immune
more realistic and logical actions. As such, these functions are both competency in protection from burnout syndrome, which could be an
stabilizing in the process of coping. People with high impulse control adequate intervention point for development of prevention programs.
think through their decisions thoroughly, while people with high
emotional control regulate their negative emotions well, they are able to Ethics
distance themselves from negative, pessimistic emotions in order to
better achieve their goals [28]. Both of these capabilities are excep­ The study was conducted with the permission of the Regional Med­
tionally important in managing stressful situations during intensive or ical and Research Ethics Committee of the University of Szeged,
emergency patientcare. Engaging clinical health psychologists in Hungary (approval No.: 237/2018-SZTE).
development of burnout prevention and intervention programs for
healthcare personnel focused on growth of psychological immune Funding
competency would present an opportunity for personal development
beneficial in managing several types of stressors. Present results indicate No external funding.
that availability of such individual and group interventions in occupa­
tional setting is vital in prevention of burnout, so drawing the attention CRediT authorship contribution statement
of management of high-risk departments to these psychological inter­
vention opportunities is as important as improvement of working con­ Mona Stankovic: Conceptualization, Methodology, Validation,
ditions and infrastructure. It is, however important to state, that the Formal analysis, Investigation, Writing – original draft. László Papp:
psychological immune competency only partially predicts burnout. Methodology, Formal analysis, Writing - review & editing. László
Further research is needed in order to map out additional – individual Ivánkovits: Conceptualization, Methodology, Validation, Formal anal­
and organizational – predictors dominant in burnout. ysis, Investigation, Writing – original draft. György Lázár: Resources,
Writing - review & editing, Supervision. Zoltán Pető: Conceptualiza­
6. Limitations tion, Resources, Writing - review & editing, Supervision. Annamária
Töreki: Conceptualization, Methodology, Validation, Formal analysis,
Present study is a cross-sectional design, which prevents the causal Investigation, Writing – original draft, Supervision.
interpretation of the data. Future research should focus on better defi­
nition of causes and consequences of burnout among intensive care

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M. Stankovic et al. International Emergency Nursing 60 (2022) 101114

Declaration of Competing Interest [24] Stavropoulou A, Rovithis M, Sigala E, Pantou S, Koukouli S. Greek nurses’
perceptions on empathy and empathic care in the Intensive Care Unit. Intensive
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