4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Emergency Department Turnover Intention: Are Job Satisfaction and Burnout Really the Main Culprits?(University of the Witwatersrand, Johannesburg, 2022-11) Jonker, Yvonne Denise; Motara, Feroza; Moolla, MuhammedBackground: Patient presentations to emergency departments (ED) keep increasing. High staff turnover is detrimental to the healthcare worker (HCW), the organisation and the patient. While high levels of burnout (BO) and low levels of job satisfaction (JS) lead to a higher intention to leave (ItL), there are other factors affecting the ItL that need to be evaluated. Objective: To determine the levels of BO, JS and ItL, including when, where and why HCWs want to leave in order to find ways to reduce staff turnover. Methods: This was a prospective observational cross-sectional study conducted in two tertiary-level EDs in Johannesburg, South Africa namely Chris Hani Baragwanath Academic Hospital (CHBAH) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Doctors and nurses were invited to complete self-administered questionnaires between 24 November 2020 and 24 March 2021. After analysis the results for doctors and nurses and the two units were compared in order to bring understanding to the different facets affecting staff turnover. Results: A total of 78 respondents (66% of doctors and 58% of nurses) completed questionnaires and were included for analysis. According to the Copenhagen Burnout Inventory 79% of CHBAH doctors, 62% of CHBAH nurses, 79% of CMJAH doctors and 84% of CMJAH nurses suffered from severe personal burnout, while 68% of CHBAH doctors, 62% of CHBAH nurses, 95% of CMJAH doctors and 68% of CMJAH nurses suffered from severe work-related BO and 42% for CHBAH doctors, 24% of CHBAH nurses, 47% of CMJAH doctors and 32% of CMJAH nurses had severe patient-related burnout. Doctors had significantly higher patient-related burnout (p=0.012). JS was average for all staff but nurses were significantly less satisfied (p=0.003). While 42% of staff intended to leave within a year, of which half wanted to leave as soon as possible, a total of 73 % wanted to leave within 5 years. CMJAH staff had higher levels of BO, lower levels of JS and higher levels of ItL. Higher levels of BO and lower levels of JS increased the ItL. The main reasons for leaving were career-related. Conclusion: Burnout levels were higher than similar populations before and during the Covid-19 pandemic, while job satisfaction levels were average. Although burnout and job satisfaction affected intention to leave, the main reasons for wanting to leave were career-related indicating that even when work conditions and burnout could be addressed successfully, the turnover of staff in tertiary level EDs may remain high.Item Exploring the relationship between job demands, resource, and psychological well-being: A study in the hospitality and tourism industries(University of the Witwatersrand, Johannesburg, 2024) Marks, Joshua Blaine; Donald, FionaIdentified as a key factor contributing to elevated levels of individual performance and thus organisational performance, ensuring ideal levels of individual psychological well-being has grown increasingly important within organisations, especially following the onset and recession of the COVID-19 pandemic. Despite the pandemic having receded, its initial impact left lasting effects on various industries, particularly the tourism and hospitality industries as these industries saw a drastic reduction in workforce size and revenue generated. This has prompted the implementation of nationwide recovery efforts; however, these have been found to be primarily aimed at addressing the financial and economic impacts of the pandemic with minimal consideration for addressing the psychological impacts of the pandemic. This study aimed at evaluating the current state of individual psychological well-being of individuals working in the tourism and hospitality industries in South Africa. Given the broad nature of the psychological well-being construct, attempts to evaluate it in the work context have proved difficult. Hence it is for this reason that this study evaluated psychological well-being with reference to the experience of work engagement and burnout, as these constructs have been conceptualised as indicators of psychological well-being. Therefore individual psychological well-being was assessed through the exploration of the potential relationships between various job characteristics and the experience of work engagement and burnout. The sample consisted of 65 participants from organisations within the tourism and hospitality industries in South Africa. Participants were required to complete a questionnaire that comprised of a demographic information section, the Job-Demands Resources Scale (JDRS), the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), and the 9-item Utrecht Work Engagement Scale (UWES-9). The results generated indicated the presence of significant, weak to moderate relationships between the variables of interest, with few exceptions. Furthermore, the significant regression models generated by the analysis provided insight into the relative contributions of the chosen job characteristics to the experience of work engagement and burnout. The results were discussed within the broader literature on the concepts of job demands and job resources, and the experience of work engagement and burnout.Item A Systematic Review Examining the use of Neurofeedback as an Intervention in the Management of Burnout(University of the Witwatersrand, Johannesburg, 2024-05-30) Patron, Daniella; Besharati, Sahba; Beukes, JohannaBackground: Burnout is highly prevalent and has a long-lasting impact on health and well-being. However, a lack of formal diagnosis and standardised definition criteria has resulted in vague measurement standards and uncertainty regarding appropriate interventions. Neurofeedback training has shown the potential to modulate patterns of stress and produce long -lasting changes in the brain. However, the efficacy of neurofeedback training and its application to burnout is still in question. Work related stress is highly prevalent and has a serious and long-lasting impact on health and well-being. One ‘occupational phenomenon’ known as burnout has affected people in a multitude of professions and across a variety of societal domains. However, burnout is not currently recognised as a formal diagnosis and has no universally applied definition criteria. Aim: This systematic review aimed to determine if neurofeedback training is an appropriate intervention for the management of burnout. The secondary aim of the study was to evaluate the methodological, procedures and practical standards by which the neurofeedback training intervention was implemented as well as how the various burnout measures and populations were represented. Methods: This review (pre-registered on PROSPERO CRD42023448860) adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Six databases (Web of Science, Scopus, Medline, ProQuest, PsycINFO and Ebscohost) and one search engine (Google Scholar) were searched according to inclusion and exclusion criteria. Exclusion criteria: unpublished material, studies published before 2003, published in languages other than English, comorbidities with other disorders, use of other EEG interventions, no mention of burnout characteristics. Findings: The search strategy yielded a total of N = 6 studies included in the final review. Study results showed neurofeedback training improved negative characteristics associated with burnout, especially when combined with other intervention methods. However, vag ueness and omission were found in most study designs and intervention protocols with inconsistent burnout measures and sampling bias. Conclusion: In conclusion, neurofeedback training has shown the potential for managing certain burnout characteristics. However, due to the inconsistent study designs and vague methodological protocols, it remains uncertain whether it is entirely effective as an intervention for burnout. Thus, there is a need for more studies to be conducted in this area with the employment of stringent and standardised study designs, clearer reporting of methodological protocols, universally applied burnout definitions and regulated measures, more ethnically diverse samples, and a focus on more representative populations from diverse domains other than adults in healthcare professionsItem The Impact of a Psychological Capital Micro-Intervention on Academic Burnout amongst First-year University Students(University of the Witwatersrand, Johannesburg, 2023-10-23) Bonga, Bulelani; Siemers, IanPurpose – the aim of this study is to probe into whether psychological capital micro interventions impact upon burnout amongst first-year university students, in the psychology department, at the University of the Witwatersrand. Research Design and Methodology - This study used a quasi-experimental design, because it did not include random assignment, but did include a comparison group, and manipulation of the DV variables. The research was quantitative in nature, with a sample size of 319 first year students from Wits University.. Findings – There was an insignificant interaction effect between group and time on all the variables. Thus, the intervention was not successful. However, Psychological capital was significantly and negatively related to burnout, and it’s components. Research limitations/implications – The sampling approach may limit the generalizability of the study’s findings as the data was collected from just one South African university, where the primary focus was first-year students. Another limitation includes the 1% given to those who participated in the intervention. Although this is departmental policy, an allocation of this nature can be interpreted as an attempt to persuade or provide an incentive, which may have affected the way the students responded. The current study has highlighted the value and importance of administering psychological capital interventions, not only in universities, but South Africa at large.Item Does it matter where I work? Examining the effect of Remote Work on employees’ Work Engagement and Burnout(University of the Witwatersrand, Johannesburg, 2023-08) Tau, Lebogang Tlotlo; Pitman, MichaelThe global COVID-19 pandemic caused a significant shift in how and where work is conducted. Governments around the world initiated national lockdowns to enforce certain restrictions to curb the spread of infection and keep society functioning as normal. Businesses and institutions had to adopt flexible, remote working arrangements to achieve their ends during the pandemic. This study examined if remote work had any effect on employees’ work engagement and burnout, and if this relationship would be moderated or mediated by work overload and organisational support in South African organisations. A cross-sectional questionnaire design was utilized to obtain data from the sample. A sample of 103 employees from different organisations in South Africa participated in the study. Work overload and organisational support was measured using their respect subscales on the Job Demands-Resource scale. The Utrecht Work Engagement Scale, Oldenburg Burnout Inventory were used to measure the work engagement and burnout respectively. The results indicate that remote work does not predict both work engagement and burnout, nor was this relationship moderated by work overload and organisational support.Item Occupational Stress and Burnout among Clinical Officers at Public Hospitals in Malawi: Impact Shifting to the General Public(University of the Witwatersrand, Johannesburg, 2023-08) Chinguwo, Paliani; Kenny, Bridget; Matshiditsho, Rajohane; Scully, BenIn Malawi, there is a cadre of mid-level health workers called clinical officers who undertake duties conventionally designated for medical doctors in the wake of an acute shortage of the latter. The use of clinical officers as substitutes for medical doctors is one example of a strategy called task shifting that is implemented as a temporary remedy for the shortage of human resources in healthcare. This is a study on the experiences of clinical officers with occupational stress and burnout at public hospitals in Malawi. The study adopted a qualitative research design with a case study as a research strategy. The study was conducted at four district hospitals and one central hospital, all of which are state-owned. One shortcoming of the framing of occupational safety and health in Malawi is the narrow scope and coverage of the regulation on occupational safety and health. This narrow scope of the regulation of occupational safety and health is limited to physical, chemical, and biological hazards. The psychosocial hazards are therefore neglected by the regulation on occupational safety and health. Another shortcoming of the framing of occupational safety and health in Malawi is that the coverage of the regulation on occupational safety and health exempts service sectors like healthcare. This exemption, therefore, gives the impression that healthcare in Malawi is immune to occupational safety and health hazards. This study challenges the narrow scope and coverage of the regulation on occupational safety and health in Malawi that neglects psychosocial hazards and exempts healthcare. The overall aim of the study was to expose the impacts on public health that can be associated with the neglect of psychosocial hazards and the exclusion of healthcare from the regulation of occupational safety and health. This study demonstrates that there are psychosocial hazards at public hospitals that predispose clinical officers to occupational stress and burnout. These are excessive workload, long hours of work, poor interprofessional relations, restructuring, COVID-19 responses, and the absence of occupational and safety management systems. The study further illustrates that psychosocial hazards at public hospitals are a breeding ground for various health problems among clinical officers that emanate from occupational stress and burnout. These health problems include emotional and cognitive effects; injuries; high blood pressure (hypertension); muscle tension or pain; and severe headaches. These health problems negatively affect the quality of life among clinical officers and their performance on the job. The study, therefore, concludes that occupational stress and burnout among clinical officers ultimately affect health outcomes in the broader population. For instance, the study demonstrates how the consequences of OS and burnout among clinical officers are consequently externalised to patients and the general public through the poor quality of healthcare services. In this study, the externalisation of the negative effects of occupational stress and burnout on clinical officers to the patients and the general public, is referred to as impact shifting. This study conceptualises and proposes a theoretical framework for analysing occupational safety and health in Malawi, with a particular focus on psychosocial hazards at public hospitals. The theoretical framework comprises three theoretical perspectives, namely: attribution theory, job demands-resources model, and fundamental cause theory. This study, therefore, offers a theoretical foundation and empirical evidence drawn from the experiences of clinical officers with occupational stress and burnout. The theoretical foundation and empirical evidence can inform the reframing of the scope and coverage of the regulation on occupational safety and health. Finally, this study also conceptualises and proposes a framework for the formulation of a comprehensive policy on occupational safety and health for public health facilities in the context of Malawi.Item A survey of the professional quality of life of pharmacists and rehabilitation therapists at three public sector hospitals in Gauteng, South Africa(2024) Moyo, NonkazimuloBackground- The global goal of Universal Health Coverage (UHC) cannot be achieved without a wellmotivated and productive health workforce. Central to their motivation and productivity is the notion of professional quality of life (ProQOL) that captures both the positive and negative emotions of caring work. However, there is a dearth of empirical studies on the ProQOL of pharmacists and rehabilitation therapists, especially in an African setting. Study aim -The aim of the study was to examine the self-reported ProQOL of pharmacists and rehabilitation therapists at three public sector hospitals in the Gauteng Province of South Africa. Methodology- During 2021, a cross-sectional analytical study was conducted at three public sector hospitals in the Gauteng Province of South Africa. Following informed consent, all eligible pharmacists, pharmacist assistants, occupational therapists, physiotherapists and speech therapists and audiologists completed a self-administered questionnaire electronically. In addition to sociodemographic information, the questionnaire obtained information on compassion satisfaction, burnout, and secondary traumatic stress using the ProQOL scale (version 5) and work-related experiences during the COVID-19 pandemic. STATA® 17 was used for descriptive and multivariate analysis of the survey data. Results- A total of 118 pharmacists and rehabilitation therapists completed the survey. The majority were female (83.00%), single (63.46%), with mean age 30.77 years (SD=9.08). The results revealed moderate mean scores for compassion satisfaction (39.62; SD=5.48), burnout (24.26; SD=5.12) and secondary traumatic stress (23.03; SD=6.31). The predictors of compassion satisfaction were moderate positive COVID-19 experiences score (β=+2.61;95% CI 0.54; 4.68; p=0.014) and high positive COVID-19 experiences score (β =+ 2.68; 95%CI 0.40; 4.96; p=0.021); moderate overall job satisfaction score (β =+ 3.17; 95% CI 0.16; 6.18; p=0.039) and high overall job satisfaction score (β =+ 7.26; 95% CI 4.06; 10.47; p<0.001). The predictors of burnout were being single (β=+2.02 95% CI 0.07; 3.97; p=0.042), full professional registration (β=+4.23; 95% CI 1.79; 6.67; p=0.001), direct involvement in patient care (β=+3.24; 95% CI 0.22; 6.26; p=0.036) and reporting a heavy workload (β=+ 2.61; 95% CI 0.75; 4.48; p=0.007). The predictors of secondary traumatic stress were being male (β=+ 3.26; 95% CI 0.36; 6.15; p=0.028), and full registration (β=+ 5.72; 95% CI 2.41; 9.03; p<0.001). Conclusion- The ProQOL of pharmacists and rehabilitation therapists is influenced by a combination of individual, workplace, and health system factors, suggesting the need for a multifaceted approach to optimise their contribution to the achievement of UHC. Such approach should include provincial health, hospital management, and peer support as well as self-care activities.Item Factors associated with burnout among healthcare workers in a rural context, South Africa: a cross-sectional study(2024) Moses, AlexandraBackground. Healthcare providers (HCP) were at risk of burnout related to high levels of occupational stress in the workplace. However, there was little research in rural and primary care settings in subSaharan Africa. This study aimed to describe the individual and workplace factors of public sector HCP working in Mpumalanga province, their experience of burnout and to examine the factors associated with burnout.. Methods. A quantitative study design using a cross-sectional survey was employed. The research site was Nkomazi Local Municipality in Mpumalanga Province. All HCPs (n=1 139) working at the primary healthcare clinics, community health centres and district hospitals were invited to participate in the survey. Data were collected between April and September 2022 via a selfadministered, electronic questionnaire. A demographic and occupational questionnaire, the General Help Seeking Questionnaire and the Health and Safety Executive (HSE) indicator tool were used to assess individual and workplace factors. Burnout was assessed using the Maslach Burnout Inventory– Human Services Survey. Univariate and multivariate regression analyses were used to examine factors associated with burnout. Results. Just over a quarter (n=302; 26.5%) of HCP participated. Participants were aged between 23 and 61 years, mostly female (n=252; 83.44%) and nurses (n=235; 77.81%). Most participants (n=215; 71.19%) would seek help if they had an emotional problem, most likely from mental health professionals, and least likely from traditional healers. Increased work-related stress was present due to the demands and roles of HCP. High levels of burnout were observed for Emotional Exhaustion (Median score 26 (IQR: 18)) and Personal Accomplishment (median score 29 (IQR: 9)) but not for Depersonalisation (median score 7 (IQR: 9)). On univariate regression analysis, the individual factor of being married and the workplace factor of increased years of experience were statistically significant to all three subscales of burnout. HSE factors of demands, control, management support, peer support, relationships, role and change were highly statistically significant to Emotional Exhaustion, Depersonalisation and Personal Accomplishment. On multivariate regression analysis, no individual demographic, occupational or HSE factors were significantly associated with Emotional Exhaustion or Depersonalisation. Personal Accomplishment ii improved by 0.49 (95%CI: 0.10-0.89) for every one point increase towards improved work demands, by 0.84 (95%CI: 0.01-1.67) for every point score increase towards improved management support, and by 1.19 (95%CI: 0.48-1.90) for every point score increase towards having improved role. Conclusions. During 2022, HCPs working in a rural area in South Africa displayed high levels of burnout for Emotional Exhaustion and Personal Accomplishment but not for Depersonalisation. Improvements in work demands, managerial support and role were significantly associated with an increase in the experience of Personal Accomplishment. Further research is recommended to better understand the nuances of the work environment. Solutions should be explored and implemented to prevent burnout, with special consideration given to work demands, managerial support and role clarity as part of the effort to retain rural HCP in the public health system.