Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

A psychiatric nurse is a registered nurse (RN) with expertise in mental illness. Psychiatric

nurses, like other nurses, conduct assessments and interviews. However, the focus is on the

patient’s feelings, emotions and reactions to the environment. A psychiatric nurse evaluates the

patient’s symptoms, daily living habits, patterns of illness, support and family life; like other

workers these nurses experience fatigue and burnout at work but on a highly different level.

Nurses are more prone to develop burnout and a major cause of it is the nature of the occupation.

Sources of stress for staff nurses in psychiatric wards include hard and inflexible policy, work

assignments appropriately to people, not to satisfy training needs, inadequate remuneration,

suicide terrified patients, conflicts between colleagues, the complexity of needs patients and their

disease is lack of recovery. There is a number mental health institutions scattered throughout the

Philippines either a private one or a public one. It is a misconception to many that some of the

nurses only entered this field for the sake of it, what they do not know is that there are some that

got this job to really help patients.

Burnout can be experienced by anyone at any time of the year. The term “burnout

syndrome” was first described in the year 1970s by Herbert J. Freudenberger. He defined it as

“the extinction of motivation or incentive, especially where one’s devotion to a cause or

relationship fails to produce the desired results” (Tartakovsky, 2015). Freudenberger first used

the term burnout to describe the feeling of failure and exhaustion that can be observed in social

workers that worked in institutions, and it was the result of immoderate requirements of energy,

effort, and qualifications. Burnout is a state of physical, mental, and emotional exhaustion that

often results from a combination of very high expectation and persistent situational stress.

Burnout not only affects psychiatric nurses' ability to provide optimal patient care, but its

consequences extend to the nurse's psychological and physical health.

1
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Each person has their own coping behaviour which is their own response to

psychological stress that may be triggered by burnout. Nursing is one of the stressful professions

mainly because it deals with human beings and their reported sickness. The presence of

workplace stress among nurses is considered as a cost factor on the health care organization.

As for the gaps in literature for burnout, one stated that there remains considerable work

to be done in integrating the range of perspectives on burnout among mental health workers.

Another one stated that job-independent factors might have contributed to the high workforce

stress rates observed and that their study did not address positive attitudes towards work, such as

job satisfaction. There are no recent literatures regarding psychiatric ward nurses locally. For

almost all the literatures the generalizations are limited.

The goals of this research is for the readers (1) to be informed of what psychiatric ward

nurses experience in terms of burnout, work performance, and coping behaviour; and (2); to

know the different and similar coping behaviours they do; and (3) the enhance the perspectives

of society about psychiatric ward nurses.

Based on research, there are limited sources in terms of public psychiatric ward nurses in

the Philippines because of this gap the researchers have not conceptualized it in term of the

Public psychiatric ward setting here in the Philippines. Also, most of the studies are outdated.

And there are limited numbers of public psychiatric ward here in Metro Manila.

The researchers choose public psychiatric ward nurses due to lack of attention given to

these nurses. There are limited sources where you can find public psychiatric ward nurses here in

the Philippines.

2
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

One significance of this study is that it would inform the audience about what dimension

of burnout is most likely experienced by the Filipino public psychiatric ward nurses; another one

would be that they will also be aware what common coping behaviours they use to manage their

burnout. This would also be an eye-opener for the administrations of the respective institutions to

be aware of what their psychiatric ward nurses experience. Another one is that this would be a

source for future researchers that also want to study public psychiatric ward nurses here in the

Philippines.

Review of Related Literature

Burnout

Burnout has been defined as a three-dimensional syndrome which includes: 1) Emotional

exhaustion (feeling emotionally drained by one’s contact with other people); 2)

Depersonalization (negative feelings and cynical attitudes toward the recipient of one’s services

or care) and, 3) Reduced personal accomplishment (a tendency to negatively evaluate one’s own

work). According to Maslach, Burnout is a syndrome and a phenomenon that most Psychiatric

ward nurses experience with their work environment and how they deal with their patients. This

syndrome is a condition in which low power and ability, and willingness and desire to work is

reduced. It is their physical and emotional exhaustion and if not acknowledge or treated, this

burnout syndrome can cause nurses to have depression and would have negative approach to

their patient, would show a lack of commitment, and are less capable of providing adequate

services, especially along dimensions of decision making and initiating involvement with clients.

There are no exact meaning of burnout because gender, age, and location of where they work can

affect the way they see and feel burnout. Good Leadership in the work place is important to

lessen the emotional exhaustion of nurses in acute general hospitals. Burnout not only affects

3
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

psychiatric nurses' ability to provide optimal patient care, but its consequences extend to the

nurse's psychological and physical health.

Burnout is caused by stress at work and the environment of their work place. The

inability to belong or adjust to that environment may cause the nurses to have Burnouts. There

are variables that this article considers for the nurses to reduce or lower the rate of burnout such

as Age, duration of total period of nursing, prior military training, locus of control, sense of

general well-being, adjustment capabilities, and emotional maturity. Not wanting the job or

profession can also cause burnout for nurses because they are trying to do what they don’t want

to do, Maslach & Leiter (2004) proposed that burnout develops as the result of mismatches

between professionals and their job contexts in several areas of working life. Specifically,

mismatch occurs when the process of establishing a psychological ‘contract’ with one’s job

leaves critical issues unresolved, or when working relationships change in such a way as to feel

unacceptable to the worker.

There are three components of burnout which are emotional exhaustion,

depersonalization, and diminished personal accomplishment. Same as the first article burnout is

caused by the atmosphere of the work place or the environment where the nurses normally work.

The work load of the nurses, hours they spend in working, opportunities at work and also how

many days in a week do they normally work can also cause burnout. Melchior et al. (2007) also

supports this study about how nurses can have burnout on their job, according to them increased

workload, lack of independence, unclear roles and responsibilities, and lack of support from

nurses are associated with this phenomenon. In the Caribbean most of the nurses their according

to the article are mostly affected by this phenomenon which is Burnout and the quality of their

work were also affected due to burnout. From the study of Maslach during 1979 until the more

4
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

studies about burnout on Mental institution and general hospital nurses today ( 2016) the rate of

burnout on nurses in Mental Institutions and general hospital have increased due to the increase

number of patients and decrease number psychiatric ward nurses, they handle more patients

today than the previous years.

Work Performance

Not many people know but psychiatric nurses can also be infected or be harmed by their

patients. Since patients are very unpredictable. Nurses confront potential exposure to infectious

diseases, patients that are hard to handle, back injuries, and many more. They are also subject to

hazards such as stress, shift work, work load, and violence in the workplace. With these

hazardous effects nurses that are working in the institution can negatively impact their job

performance.

With the existence of burnout among the nurses in a mental institution, the work

performance of each decreases. Work performance may be negative if the nurses does not feel

satisfied with his or her work or if he or her feels any burnout in working. Work performance can

be seen on the attendance of the nurses and the evaluation done by the chief of nurses. It is

through the attendance it can seen if they go to work every day or if absenteeism happens. And

with the evaluation that the chief of nurses would know how the nurses are performing at work.

Coping Behavior

Coping is a vital part of any person’s survival in today’s fast-paced healthcare

environment. Lazarus and Folkman (1984) noted, “Coping serves two overriding functions:

managing or altering the problem with the environment causing distress (problem-focused

5
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

coping), and regulating the emotional response to the problem (emotion-focused coping)” coping

is an activity we do to seek and apply solutions to stressful situations or problems that emerge

because of our stressors. Actually, the term "coping" is more associated with "reactive coping",

because in general, we see coping as a response to a stressor.

Coping is a central part of this process includes overt and covert response to threat or

danger usually directed towards overall reduction of stress. Coping behaviors are connected to

different problems that a nurse in a psychiatric ward experiences like work-related stress, fatigue

and many more. Coping is viewed in this formulation as having two major functions: the

regulation of emotion and distress (emotion focussed coping) and the management of problem

that is causing the stress (problem focussed coping) these two functions of coping have been

recognised by numerous investigators (Kann, Wolfe, Quinn, Snood and Rosenthal, 1964) and

have long been implicitly recognised by clinicians.

According to Antonovsky (1987), a strong sense of coherence is not a particular coping

style, and the stressors life imposes are many and varied. To adopt one pattern of coping

consistently is precisely to fail to respond to the nature of the stressor, and hence to decrease the

chances of successful coping. The results of coping in the sample show that the emotion-

oriented and problem-oriented coping strategies are employed equally, as there are minimal

differences in their mean values. The prevailing ways of coping stress in the sample, after

assessment of the indicators in the scales, are planful problem solving (characterizes problem-

oriented coping strategy), self-controlling and positive reappraisal (characterizes emotion-

oriented coping strategy), which may indicate that these ways of coping are used by the sample

more frequently. Their coping behavior helps them to balancing their stress from work and their

willingness to help their patient or other people. Nursing focuses on activities that relate to

6
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

diagnosis and treatment of human responses to health and illness phenomena. However, inherent

in this caring occupations are numerous sources of built-in stress that become occupational

hazards for nurses. A person’s coping behavior plays an important role in resolving difficult

conflict situations that may arise in various spheres of life. In Heim’s (1988) opinion, coping

behavior shows itself in the cognitive and emotional actions that a person takes to overcome

difficult situations and to adapt to existing circumstances.

Conceptual Framework

The goals of the study is to determine which dimension of burnout is more commonly

experienced by public psychiatric ward, what is the level of burnout that the psychiatric ward

nurses experience, and what are their common coping behaviours. The researchers would like to

show the most common burnout among public psychiatric ward nurses, and what are the most

utilized coping behaviours. Psychiatric Nursing is regarded as a straining occupation. It is known

that burnout is most commonly experience by helping professions; one of them being a

psychiatric ward nurse. Studies show a prevalence of 30% - 78% in terms of burnout being

common (Doolittle, 2013).

The thought of mental health institutions are viewed by society in a negative way. These

views may have been caused by history in which it tells how those who were suspected of having

a mental illness have been locked up in asylums and cut their brain to “treat” their illness. While

the public’s perception of mental health nurses is not always favorable, the nursing profession

also views mental health nurses in less than a favorable light. Many of the peers in other

specialties views psychiatric nurses as inferior and not real nurses, and have at times been

7
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

overheard by one of the authors telling non-mental health nurses that mental health nurses are

crazy.

Research has shown that mental health professionals who work with severely mentally

ill patients experience a considerable amount of stress that can end up as burnout and can be

detrimental to patient care (Sorgaard, Ryan, Hill, & Dawson, 2007).

Studies have examined burnout rates in various mental health professions, as well as

assessing burnout rates when clinicians work with particular client populations (Sorgaard et al.,

2007).

Mental health care workers face additional strain by the very nature of their professions

and as a result may be more at risk than their colleagues who work in a more physical

environment (Moore & Cooper 1996, Nolan etal. 1995). There are various factors, which are:

handling people with mental illness, the facilities of the institution, shifts, and working with

colleagues in which psychiatric ward nurses undergo that can cause difficulties. There are little

to none studies that state their definite problems they can experience. No matter what they state

some of it might not be applicable to others. People who chose this kind of profession are more

prone to factors that may give them an amount of difficulties and burnout that can leave a

negative outlook when it comes to their jobs.

8
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Public Psychiatric Ward Nurses

Burnout

Disengagement and
Exhaustion

Work Performance Coping Behaviours

- Attendance - Self-distraction
- Absenteeism - Active coping
- Shifts - Denial
- Substance use
- Use of emotional
support
- Use of instrumental
support
- Behavioral
disengagement
- Venting
- Positive reframing
- Planning
- Humor
- Acceptance
- Religion
- Self-blame

9
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Public psychiatric ward nurses experiences burnout that can be specified into two

dimensions which are; disengagement and exhaustion. With this experiences of burnout,

psychiatric ward nurses may affect their work performance. Their coping behaviours are their

ways to deal with the said experiences. This study aims to know which among these coping

behaviours are the most utilized and which among this dimensions of burnout are the most

commonly experienced by the public psychiatric ward nurses.

Statement of the Problem

This study attempts to identify how burnout affects work performance of

psychiatric ward nurses and how does coping behavior affect burnout and work performance.

To be specific, the study would like to find out the answer to the following questions:

1. Which dimension of burnout is more commonly experienced by public psychiatric ward

nurses?
2. What are their coping behaviors?

3. How does coping behaviours affect the feeling of burnout?

Research Design

The researchers will use qualitative descriptive research design. According to Denzin and

Lincoln (2011), qualitative descriptive research design is an inductive and flexible nature of

research that uses inductive style of questioning and research. It is also a research that explores

attempts at gaining an understanding of underlying reasons, opinions and motivations of

concepts or phenomenon.

10
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Participants

The technique that the researchers used is purposive sampling. It is where you select and

have criteria for choosing the kind of participants. Purposive Sampling would rely on the

researchers own judgment and basis to select the participants.

The participants of this study will be from the 10% of the total population of psychiatric

ward nurses in a public institution who are in service for 5-10 years within National Capital

Region. Participants would be a pure Filipino, a registered nurse, and should be a regular nurse

in the institution. Participants should not have minor medical condition or illnesses, have no

experience working abroad, and should not be living near the workplace.

Instruments

The instruments that the researchers will be using are the Oldenburg Burnout Inventory

includes positively and negatively framed items to assess the two core dimensions of burnout:

exhaustion and disengagement (from work). Exhaustion is defined as a consequence of intense

physical, affective and cognitive strain, i.e. as a long-term consequence of prolonged exposure to

certain job demands while disengagement in the OLBI refers to distancing oneself from one’s

work in general, work object and work content (e.g., uninteresting, no longer challenging, but

also “disgusting”) (Demerouti & Bakker, 2008).

The Brief COPE Inventory is the shorter form of COPE Inventory which has 60-items

wherein the Brief COPE has only 16-items. The researchers deemed it important to use the

shorter version because they do not want to take up much of the participants’ time. According to

Carver (1998), he and colleagues "tuned" some of the scales somewhat (largely because some of

the original scales had dual focuses) and omitted scales that had not appeared to be important. In

11
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

this way the positive reinterpretation and growth scale became positive reframing (no growth);

focus on and venting of emotions became venting (focusing was too tied to the experiencing of

the emotion, and we decided it was venting we were really interested in); mental disengagement

became self-distraction (with a slight expansion of mentioned means of self-distraction). They

also added one scale that was not part of the original inventory--a 2-item measure of self-blame--

because this response has been important in some earlier work.

The researchers will also ask the attendance and/or evaluations of the nurses from the

chief of nurses.

Data Analysis

25

20
Average scores

15

Disengagement
10
Exhaustion

0
1 2 3 4 5 6
Participants according to years in service

Figure 1. Average scores of participants in Oldenburg Burnout Inventory

For the data analysis of their burnout, the participants are arranged from the lowest

number of years, which is 5 years, to the highest number of years, which is 10 years. For

participant 1, 3, and 5 they have a high amount of disengagement but a low amount of

exhaustion. While for participants 2, 4, and 6 have the opposite outcome. Though the difference

12
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

of their burnout are not that big, it still illustrated that the newer the nurse is in service the higher

the burnout. Ultimately, participant 6 who is in service for 10 years already has the overall

lowest burnout.

Top Coping Behaviours

Self-distraction
3% 7% Active Coping
11% Denial
9%
Substance Use

9% 3% Use of Emotional Support

3% Use of Instrumental Support

Behavioral Disengagement

9% Venting
11%
Positive Reframing
Planning
8% Humor
9%
Acceptance
11% 3%
4% Religion
Self-blame

Figure 2. Coping behaviours in percentages

There are three coping behaviours that the participants seem to commonly use which are

positive reframing, religion and the use of emotional support. The next ones are acceptance,

active coping, humor and the use of instrumental support. The least coping behaviours are self-

blame, behavioural disengagement, denial and substance use.

13
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

The results showed that the participants use positive coping behaviours and disregards the

negative ones. Studies show that the top behaviours seen above are affected by the Filipino

culture.

Results

Based from the results of the Oldenburg Burnout Inventory, it was found out that the

participants with less years of experience, the higher the Disengagement and the lower

Exhaustion. Compared to the other participants with the higher years of experience, it was the

opposite for them. They have low Disengagement tendencies and have higher Exhaustion

tendencies.

From what the researchers have gathered, all of the psychiatric nurses are always present

in work. The chief of nurses said that they are present at work every week days and they are off

every weekends but if the institution needs more man power they are asked to work even during

their day off. It is also said that their performance is highly commendable.

As for the results of the Brief COPE Inventory, it was shown that the longer they are in

service of being a psychiatric nurse the lesser their coping behaviours. Compared to the ones

with a fewer years who only uses 2 – 3 coping behaviours.

There were 14 coping behaviours in the inventory and out of these, 3 were the most

commonly used coping behaviours; these are Use of Emotional Support is about helping to lift

someone to higher ground so he or she can see their way through the difficulty, Religion wherein

they turn to their respective higher Being and pray, and Positive Reframing is when the person

views the motives and actions of others in a positive light.

14
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Overall, the results showed that the longer they have been working as a psychiatric nurse

the lower chance of them disengaging from work but has a higher chance of being more

exhausted. And the shorter they have been in service shows that they are more likely to feel

disengagement from work and is least likely to feel exhausted. Though their coping behaviours

are helping them balance out their burnout and struggles. Even if the nurses have high burnout, if

their work performance is high it is seen that their coping behaviours are effective and helpful for

them to cope with the feeling of burnout at work.

Table 1
Summary of Participants’ answers to the instruments OLBI and Brief COPE Inventory
Participants 1 2 3 4 5 6

Burnout

Disengagement 20 17 19 18 18 12
Exhaustion 16 18 15 19 16 15

Coping Behaviours

Self-distraction 5 6 6 5 5 5
Active coping 6 6 6 6 6 8
Denial 2 2 4 5 2 6
Substance use 2 2 2 2 2 2
Use of emotional support 7 8 6 8 6 5
Use of instrumental support 6 6 6 6 6 5
Behavioral disengagement 2 2 2 2 2 4
Venting 3 4 4 4 5 6
Positive reframing 7 6 8 5 6 7
Planning 5 6 6 7 5 7
Humor 6 6 6 6 4 6
Acceptance 6 7 6 7 7 6
Religion 7 6 8 8 3 8
Self-blame 2 4 7 4 5 3

15
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Discussion

One aim of the study is to find out to what extent does the psychiatric ward nurses

experience burnout and what coping behaviours they commonly use. In order to investigate this,

the researchers used the standardized tests Oldenburg Burnout Inventory and the Brief COPE

Inventory.

According to Brooks (2011), being a psychiatric ward nurse is not always dangerous but

it is always unpredictable. It takes a special breed to be a nurse in psychiatric nursing. It can get

very scary, and that’s where having a team of nurses, attendants, and patient assistance can be

critical for your own safety. The work can be emotionally and physically draining.

Ms. Ledingham (2015) explained that “burnout has long been a problem in mental health

workplaces and remains so despite much research and considerable knowledge of it amongst

professional employees. Despite working in this sector employees struggle to avoid burnout.”

She continued “It is concerning that some found it difficult to recognize burnout in themselves

until signs of physical and emotional breakdown had affected their work.”

In the Oldenburg Burnout Inventory there are two dimensions that were measured, which

were disengagement and exhaustion. It was expected that one of the two would be more

experience by the participants and the data revealed that it’s neither because it all depends on

how long the participant have been in service. However, through calculating the mean it was

revealed that disengagement is 2% higher than exhaustion. The participants have a higher

tendency to detached themselves from work rather than just being exhausted from it.

16
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

As shown in the results, it was found out that the longer the nurse is in service the lower

for them to have burnout tendencies but it does not particularly mean they do not use various

coping behaviours. It was also found out that the longer they are in service then more likely they

use multiple coping behaviours to help with their burnout and because of this they are more

likely to have a better work performance.

The common coping behaviours they all have are Use of Emotional Support, Religion,

and Positive Reframing. With a percentage of 11% these behaviours were the most chosen by the

participants.

For Filipinos, values are an important part of their life. The researchers believe that those

values affected the results of the Brief COPE Inventory. The values or culture of the Filipinos

can be seen in the common behaviours mentioned above. They are known to be quite religious,

hold importance of their personal and social relationships, and have a fun-loving trait.

More than 86 percent of the population is Roman Catholic, 6 percent belong to various

nationalized Christian cults, and another 2 percent belong to well over 100 Protestant

denominations. (Miller, n.d.) Culturally, Filipinos are firm believers of religion and higher

Being. They turn to their respective beliefs ones they encounter problems and as such pray to

their God to help them.

They do not solely rely on spiritual beings to help them. Most of their morals or ideal was

taught to them ever since childhood and growing up it strengthened and held it close to their

heart. They love to socialize with others and through this they form a strong bond and depend on

one another in times of need. This bond they share will eventually be the road to open up and

share their struggles. After sharing, emotional supports from family or peers immediately come.

17
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

In some way emotional support can also be equal to Bayanihan, a Filipino value wherein you

extend a helping hand without expecting something in return.

According to the Happiness Index Report (2016), the most important factor for Filipinos

to feel satisfied at work is having good relationships with their colleagues. “It's the Filipino

culture. We're highly relational and we want to establish personal relationships with the people

we spend a third of our day with.” (Gioca, 2016)

According to the American Institute of Stress (2012), the wisdom of the ages, anecdotal

reports, numerous clinical studies, a wealth of epidemiologic data on death rates in married,

single and divorced individuals as well as sophisticated psychophysiologic and laboratory testing

all confirm that strong social and emotional support is a powerful stress buster that improves

health and prolongs life. Laboratory studies show that when subjects are subjected to stress,

emotional support reduces the usual sharp rise in blood pressure and increased secretion of

damaging stress related hormones.

In addition, David Shedd (n.d) stated that an emotionally supportive relationship is

defined by the safe sharing of personal feelings and concerns, honestly and openly, and a lack of

a feeling if being judged by the other person.

Filipinos have the tendency to have a positive perspective whenever something negative

happens. Positive reframing does not change the situation, but it can certainly reduce damage and

put things into a healthier perspective. (Breazeale, 2012) They turn an unenthusiastic situation

into an optimistic one instead of staying in that state.

18
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

The researchers believe that the Filipino’s culture and values are some factors of how and

why use of Emotional Support, Religion, and Positive Reframing are the top coping behaviours.

Their coping behaviours affect their burnout in way that it lessens with continuous use.

The longer they are in service, the feeling of burnout the psychiatric ward nurses feel lessen with

their selected type of coping behaviour.

Conclusion

Therefore, the researchers conclude that the longer a psychiatric nurse is in service then

most likely their burnout would be lower than those nurses who are new or just starting in the

field. Both dimension of burnout is experienced by public psychiatric ward nurses. The feeling of

burnout does not vary with the years they have rendered in the institution. With experience of

burnout on the nurses, it doesn’t affect their work performance.

Coping behaviours of the ones who have longer years are greater than those who have

shorter in being a psychiatric nurse. Psychiatric nurses use multiple coping behaviours to lessen

the burnout they feel in their type of work. The researchers’ assumptions are the longer the years

in service the more they can find ways in coping with their experiences. Since spirituality is one

of the most utilized coping behavior, with our culture and Filipino nature, we always seek for

God’s help in dealing with our problems and difficulties.

Recommendations

The following are recommendations to further improve this study.

1) In terms of related literatures, it would be better to go to different schools that have

access in different portals for researching related literatures.

19
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

2) Emails and texts does not apply on this kind of research, due to their busy schedule at

work, their work load, and the people they are handling (nurses, staffs, and patients). It

would be better to call the institution or go there directly to ask the chief of the institution

if you can do your research there. In that case, the chief of the institution can give you

direct schedule and instructions.

3) You can also research on public mental health workers and not focus on psychiatric ward

nurses to have more relevant findings.

4) Find other ways like interviews and/or tools to know and to measure work performance

of each nurses.

20
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

References

A Study of the Coping Strategies Used by Nurses Working in the Intensive Care Units of
Hospitals Affiliated to Jahrom University of Medical Sciences (2015) Retrieved from:
http://www.ijcmas.com/vol-4-4/Somayeh%20Ramezanli,%20et%20al.pdf
Breazeale, R., PhD. (2012, September 25). “Positive Reframing” as Optimistic Thinking.
Retrieved from https://www.psychologytoday.com/blog/in-the-face-adversity/201209/positive-
reframing-optimistic-thinking

British Psychological Society (BPS). (2015, January 9). Mental health workers don't recognize
their own burnout. ScienceDaily. Retrieved February 7, 2017 from
www.sciencedaily.com/releases/2015/01/150109045554.htm

Brooks, A. (n.d.). ‘Nurses Experiences’ in Psychiatric Units with High Risks of Assault.
Retrieved from http://angelabrook.com/nurses-experiences-in-psychiatric-units-with-high-risks-
of-assault

Burnout in Psychiatric Nurses: Contributions of the Work Environment and a Sense of

Coherence, (2014, June) Retrieved from: http://sap.sagepub.com/content/30/2/36.short

Burnout in staff working at the Mathari psychiatric hospital (2008, November) Retrieved from:
http://www.omicsonline.com/open-access/JOP/burnout-in-staff-working-at-the-mathari-
psychiatric-hospital-jop-11-197.pdf

Goldsmith, B., PhD. (2011, December 16). 10 Ways to Get and Give Emotional Support.
Retrieved from https://www.psychologytoday.com/blog/emotional-fitness/201112/10-ways-get-
and-give-emotional-support

Influence of perceived organizational factors on job burnout: survey of community mental health
staff (2009, November) Retrieved from: http://bjp.rcpsych.org/content/195/6/537

Internal predictors of burnout in psychiatric nurses: An Indian study (2012, December)

Retrieved from:
http://search.proquest.com/docview/1444145607/42312CEF9E0E4DA1PQ/3?accountid=34320

Jiao, C. (2016, September 1). Filipinos are happiest workers in Asia - JobStreet. Retrieved from
http://cnnphilippines.com/business/2016/09/01/Filipinos-happiest-workers-Asia-JobStreet.html

Libertymichel112. (2015, May 14). Community psychiatric nurse performance appraisal.

Retrieved from http://www.slideshare.net/libertymichel112/community-psychiatric-nurse-
performance-appraisal

21
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Miller, J. (n.d.). Religion in the Philippines. Retrieved from

http://asiasociety.org/education/religion-philippines

Nursing Burnout at a General Healthcare Facility and a Mental Healthcare Institution in the
Caribbean (2012, November) Retrieved from:
http://search.proquest.com/docview/1234056920/42312CEF9E0E4DA1PQ/55?accountid=34320

Nurses burnout in psychiatric wards (2015, September-October 17) Retrieved from:

http://jfmh.mums.ac.ir/?_action=showPDF&sc=1&article=4789&_ob=e4499bfde74ca867c1572e
13e7b1eab0&fileName=full_text.pdf

Occupational stress, sense of coherence, coping, burnout and work engagement of registered
nurses in South Africa (2009, January) Retrieved from:
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-07632009000100001

Oredito, M. C. (2014, March 21). Filipino culture and values. Retrieved from
http://www.slideshare.net/dancinglady023/filipino-culture-and-values

Perceived Stressors, Coping Strategies, and Burnout Pertaining to Psychiatric Nurses Working
on Locked Psychiatric Units (2006, October 21) Retrieved from:
http://commons.emich.edu/cgi/viewcontent.cgi?article=1083&context=theses

Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care
General Hospitals (2010, March 30) Retrieved from: http://sci-
hub.io/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856615/
Relation between Job Satisfaction and Job Performance in Healthcare Services☆. (n.d.).
Retrieved February 07, 2017, from
http://www.sciencedirect.com/science/article/pii/S1877042815012860
Sevilla, K. (2013, May 29). Filipino values. Retrieved from
http://www.slideshare.net/Kate_JRG/filipino-values-22162229

Stress and Coping Mechanisms (2012, November 13) Retrieved from:

https://explorable.com/stress-and-coping-mechanisms
Stress Coping Mechanisms and Professional Burnout among Latvian Nurses (2014, December
23) Retrieved from: http://www.sciencedirect.com/science/article/pii/S1877042814064994
The American Institute of Stress. (2012). Retrieved from http://www.stress.org/emotional-and-
social-support/

The role of time perspective in coping behavior (2013, March 11) Retrieved from:
http://psychologyinrussia.com/volumes/pdf/2013_3/2013_3_120-131.Pdf
Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses (2008, January 8)
Retrieved from:

22
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Ta
bleofContents/vol132008/No1Jan08/ArticlePreviousTopic/WhyEmotionsMatterAgeAgitationand
BurnoutAmongRegisteredNurses.html

23
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Appendixes

24
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

Oldenburg Burnout Inventory

Instructions: The following statements refer to your feelings and attitudes during work. Please
ENCIRCLE the number that indicates to what extent you agree with each of the following
statements by selecting the number that corresponds with the statement.

Strongly Agree Disagree Strongly

Agree Disagree

I always find new and interesting aspects in 1 2 3 4

my work

There are days when I feel tired before I 1 2 3 4

arrive at work

It happens more and more often that I talk 1 2 3 4

about my work in a negative way

After work, I tend to need more time than in 1 2 3 4

the past in order to relax and feel better

I can tolerate the pressure of my work very 1 2 3 4

well

Lately, I tend to think less at work and do my 1 2 3 4

job almost mechanically

25
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

I find my work to be a positive 1 2 3 4

challenge

During my work, I often feel emotionally 1 2 3 4

drained

Over time, one can become disconnected 1 2 3 4

from this type of work

After working, I have enough energy for my 1 2 3 4

leisure activities

Sometimes I feel sickened by my work tasks 1 2 3 4

After my work, I usually feel worn out and 1 2 3 4

weary

This is the only type of work that I can 1 2 3 4

imagine myself doing.

Usually, I can manage the amount of my 1 2 3 4

work well

26
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

I feel more and more engaged in my 1 2 3 4

work

When I work, I usually feel energized 1 2 3 4

27
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

These items deal with ways you've been coping with the stress in your life. There are many ways
to try to deal with problems. These items ask what you've been doing to cope. Different people
deal with things in different ways. Each item says something about a particular way of coping.
Try to rate each item separately in your mind from the others. Make your answers as true FOR
YOU as you can. Please ENCIRCLE the number of your answer.

I've been
I haven't
I've been doing I've been
been
doing this this a doing this
doing this
a little bit medium a lot
at all
amount

I've been turning to work or other activities to 1 2 3 4

take my mind off things.

I've been concentrating my efforts on doing 1 2 3 4

something about the situation I'm in.

I've been saying to myself "this isn't real." 1 2 3 4

I've been using alcohol or other drugs to make 1 2 3 4

myself feel better.

I've been getting emotional support from 1 2 3 4

others.

I've been giving up trying to deal with it. 1 2 3 4

I've been taking action to try to make the 1 2 3 4

situation better.

I've been refusing to believe that it has 1 2 3 4

happened.

I've been saying things to let my unpleasant 1 2 3 4

feelings escape.

I’ve been getting help and advice from other 1 2 3 4

people.

I've been using alcohol or other drugs to help 1 2 3 4

me get through it.

I've been trying to see it in a different light, to 1 2 3 4

make it seem more positive.

28
Burnout, Work Performance and Coping Behavior of Public Psychiatric Ward Nurses

I’ve been criticizing myself. 1 2 3 4

I've been trying to come up with a strategy 1 2 3 4

about what to do.

I've been getting comfort and understanding 1 2 3 4

from someone.

I've been giving up the attempt to cope. 1 2 3 4

I've been looking for something good in what 1 2 3 4

is happening.

I've been making jokes about it. 1 2 3 4

I've been doing something to think about it 1 2 3 4

less, such as going to movies, watching TV,
reading, daydreaming, sleeping, or shopping.

I've been accepting the reality of the fact that it 1 2 3 4

has happened.

I've been expressing my negative feelings. 1 2 3 4

I've been trying to find comfort in my religion 1 2 3 4

or spiritual beliefs.

I’ve been trying to get advice or help from 1 2 3 4

other people about what to do.

I've been learning to live with it. 1 2 3 4

I've been thinking hard about what steps to 1 2 3 4

take.

I’ve been blaming myself for things that 1 2 3 4

happened.

I've been praying or meditating. 1 2 3 4

I've been making fun of the situation. 1 2 3 4

29