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.
Da a A ailabili y S a emen :
The da a p esen ed in his s udy a e a ailable on eques om he
co esponding au ho . The da a a e no publicly a ailable due o e hical.
Acknowledgmen s:
This a icle o ms pa o he Doc o al Thesis o he co esponding au ho
(Lau a P adas-He nández) wi hin he Psychology doc o al p og am o e ed a he Uni e si y o
G anada (Spain).
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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