Background
Staff burnout is a concerning issue, particularly amongst those who work in stressful work environments with extended or shift hours such as aged care workers. COVID-19 pandemic intensified the situation with the uncertainties of the pandemic, staff contracting COVID-19, and tighter measures being implemented to prevent situations worsening. [1, 2] Amongst a group of nursing staff, those who reported a lower level of burnout, also demonstrated a higher level of resilience (the ability to bounce back from stressful or difficult situations). [3, 4] This suggests that those with higher resilience are less prone to burnout.
Measuring resilience and burnout among staff may prompt interventions and supports to prevent and address burnout. Valid and reliable tools that can accurately measure the condition of the staff in the aged care workforce could therefore be valuable.
What we did
We conducted an environmental scan and literature searches to find existing tools or measures of burnout and resilience amongst the aged care workforce, initially with a particular focus on the ones used in the Australian setting. A three-pronged search strategy was used to identify these tools. Searches were undertaken 10-17 November 2022 and involved:
• structured searches using the Advanced Search version of Google
• scanning of key Australian websites
• Google Scholar and focused PubMed searches.
What we found
We found four tools that have been used to measure burnout amongst aged care staff in Australia. One was developed and pilot tested in Australia, whilst the remaining three were from other countries. An additional three tools have been used to measure burnout among healthcare workers in general in Australia (not only aged care staff). We identified six tools that have measured burnout amongst service workers (including aged care staff) in other countries. We also found a Burnout Self-Test, which is an online tool to check oneself for burnout.
We found one tool that was used to measure resilience among aged care workers and which is commonly used elsewhere as it is a generic measure of resilience. [3]
Maslach Burnout Inventory (MBI)
The Maslach Burnout Inventory (MBI) tool is the most commonly used measure of burnout among aged care workers, particularly those in residential settings. [1, 2] The MBI was developed to assess occupational burnout and includes subscales on emotional exhaustion, depersonalisation and personal achievement. [5] The MBI was found to have good validity and reliability properties. It has 16-22 items depending on which version is used and is scored using a 0-6 Likert scale (0 – never, 6 – everyday), relating to the frequency of experiencing the questions listed in tool. Higher scores reflect higher burnout risk. The MBI can be administered by anyone collecting the data for an organisation or can be self-administered. It takes approximately 10 minutes to complete.
There are several versions that have been developed specific to different groups of population who may need to be assessed for burnout. [6] These include the MBI - Human Services Survey (MBI-HSS), MBI-HSS (MP) for medical personnel, MBI (ES) for educators, MBI- GS for general use and MBI-GS (S) for students. Among aged care workers, the MBI-GS and MBI - Human Services Survey (MBI-HSS) were the ones identified to be more appropriate to use.
Licensed copies of the MBI tools can be purchased via the Mind Garden website available here: https://www.mindgarden.com/117-maslach-burnout-inventory-mbi.
Oldenburg Burnout Inventory (OLBI)
The Oldenburg Burnout Inventory (OLBI) is another tool that has been used to measure burnout among aged care workers in Australian residential settings. [1, 2] It includes subscales on exhaustion and disengagement but not necessarily occupation specific. [7] The OLBI was found to have good validity and reliability properties. It has 16 items and is scored using a 1-4 Likert scale (1- strongly agree, 4- strongly disagree). Some questions need to be reverse coded before calculating the total score. Higher scores indicate higher levels of burnout. The OLBI can be administered by anyone collecting the data for an organisation or can be self-administered.
The OLBI tool can be used free of charge and accessed here: http://www.goodmedicine.org.uk/sites/default/files/assessment%2C%20burnout%2C%20olbi.pdf
A pilot tool to assess the perception of nursing staff about stress and burnout in Australian aged care settings
A pilot tool was developed to assess the perception of nursing staff in Australian aged care settings about stress and burnout. [8] The tool was found to have an overall good internal consistency for the stress or burnout subscales which include work environment, burnout, control, job satisfaction, psychosocial stressors and symptoms and personality/behaviour. It has 52 items and items are scored using a Likert Scale which varies in number depending on the item question. Higher scores indicate higher levels of stress and burnout. The tool was sent as questionnaire for respondents to complete.
This pilot tool was part of a PhD project and can be accessed here: https://ris.cdu.edu.au/ws/portalfiles/portal/22700266/Thesis_CDU_42476_Skinner_V.pdf
Adapted COVI-Prim Survey
The Covi-Prim Survey was developed in Austria to investigate the role played by general practitioners (GPs) in the early phase of the COVID-19 pandemic, their challenges, concerns, and the strategies they have developed to cope with the pandemic. [9] The original version has a total of 58 items that covered eight demographic items, 48 closed items and two items requiring GPs to provide exact numbers. An adapted version of this survey was developed for use in the Australian residential aged care workforce (not only GPs). It has a total of 60 items that included a question about suffering from burnout. [10] The questions are answerable by yes, no or not applicable and some are open-ended questions. It was pre-tested for intelligibility of content and design by four Australian healthcare professionals and researchers. The survey tool was sent as a questionnaire for respondents to complete.
The survey tool can be used free of charge and accessed here: https://www.ajan.com.au/index.php/AJAN/article/view/490
Burnout Measure (BM)
The Burnout Measure (BM) was developed to measure burnout in terms of exhaustion amongst diverse groups of occupations including health providers. [11] It was found to be a valid and reliable research instrument with high internal consistency and level of stability. It has 21 items scored on a seven-point scale, ranging from never to always and focused on individual's physical, emotional, and mental exhaustion. The higher the score, the higher level of exhaustion and burnout is experienced.
The BM tool can be used free of charge and accessed here: https://www.wilmarschaufeli.nl/publications/Schaufeli/113.pdf
Copenhagen Burnout Inventory (CBI)
The Copenhagen Burnout Inventory (CBI) tool is a measure of burnout inspired by the Burnout Measure (BM) and the Maslach Burnout Inventory (MBI), where the core considerations are about fatigue and exhaustion. [12] The tool was found to have high validity and internal reliability. It has three subscales that include personal burnout, work-related burnout, and client-related burnout. It has 19 items and scored using a five-point Likert scale focused on the frequency (never to always) and the degree or magnitude (very low to very high degree) of experiencing the questions in the tool. The higher the scores reflect higher burnout levels.
The CBI tool can be used free of charge and accessed here: https://nfa.dk/da/Vaerktoejer/Sporgeskemaer/Sporgeskema-til-maaling-af-udbraendthed/Copenhagen-Burnout-Inventory-CBI
Hamburg Burnout Inventory (HBI)
The Hamburg Burnout Inventory (HBI) is a measure of burnout that aimed to address the shortfalls of the Maslach Burnout Inventory (MBI) and Burnout Measure (BM). [13] The tool was found to have adequate validity and reliability. It includes subscales on emotional exhaustion, distance, personal accomplishment, depressive reaction, helplessness, inner void, tedium, inability to unwind, overtaxing oneself and aggressive reaction. The tool has 40 items and no information about scoring is available.
Copies of the HBI tool can be purchased via the Burnout Institute of North Germany website available here:
https://www.burnout-institut.eu/
Maslach Burnout Toolkit for Medical Personnel
The Maslach Burnout Toolkit for Medical Personnel is a combination of the Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS). [14] The toolkit measures both the extent and likely cause of burnout.
Licensed copies of the MBI tools can be purchased via the Mind Garden website available here:
https://www.mindgarden.com/329-maslach-burnout-toolkit-for-medical-personnel
Areas of Worklife Survey (AWS)
The Areas of Worklife Survey (AWS) evaluates the workers’ perceptions of workplace attributes that may determine if they experience work engagement or burnout. [15,16] The AWS is a short companion questionnaire to the MBI, with good reliability and validity across a diverse occupational settings. It includes subscales on workload, control, reward, community, fairness and values. The AWS has 29 items scored on a five-point Likert-scale, ranging from strongly disagree to strongly agree. The higher the score, the higher the degree of perceived alignment between the working conditions and the respondent’s preferences.
Licensed copies of the AWS tools can be purchased via the Mind Garden website available here:
https://www.mindgarden.com/274-areas-of-worklife-survey
Burnout Assessment Tool (BAT)
The Burnout Assessment Tool (BAT) was developed as measure of burnout appropriate for both individual and group assessment. [17] The BAT includes subscales on core dimensions of burnout (BAT-C; exhaustion, mental distance, cognitive impairment, emotional impairment) and secondary dimensions (BAT-S; psychological complaints, psychosomatic complaints). The tool was found to have good validity and moderate to high reliability. It has 33 items scored on a five-point Likert scale, from never to always. Higher scores reflect higher levels of burnout.
Copies of the BAT can be used free of charge and available here:
Schaufeli WB, Desart S, De Witte H. Burnout Assessment Tool (BAT)-development, validity, and reliability. Int J Environ Res Public Health. 2020;17(24):9495. doi:10.3390/ijerph17249495
Burnout Measure – Short version
The Burnout Measure Short (BMS) version was developed for ease of use among practitioners and researchers measuring burnout. [18] It was based on the original version of the BM and includes concepts of the experience of burnout on person’s level of physical, emotional and mental exhaustion. It was found to be a valid and reliable measure of burnout. It has 10 items and scored on a seven-point frequency scale, ranging from never to always. Higher scores reflect higher levels of burnout.
Copies of the BMS can be used free of charge and available here:
Malach-Pines A. The Burnout Measure, short version. Int J Stress Manag. 2005;12 (1): 78-88.
Shirom Melamed Burnout Measure (SMBM)
The Shirom Melamed Burnout Measure (SMBM) is a measure of burnout in relation to exhaustion of the individuals’ energetic coping resources. [19] The SMBM has subscales on physical fatigue (a feeling of tiredness and low energy), cognitive weariness (a feeling of reduced mental agility), and emotional exhaustion (a lack of energy to display empathy to others). The tool was found to have good validity and reliability. It has 14 items scored using a seven-point Likert scale, ranging from almost never to almost always. Higher scores indicate higher levels of burnout.
The SMBM tool can be used free of charge and accessed here:
Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases, Behav Med. 1992;18(2):53-60, doi: 10.1080/08964289.1992.9935172
Utrecht Burn-Out Scale (UBOS-A)
The Utrecht Burn-Out Scale (UBOS) is the Dutch version of the Maslach Burnout Inventory – General Survey (MBI-GS). [20] It has subscales of exhaustion, cynicism and professional efficacy and was found to have high reliability. The UBOS has 15 items scored on a seven-point Likert scale, ranging from never to daily. The higher the score, the higher the burnout levels.
Refer to the MBI for items in the UBOS tool. Licensed copies of the MBI tools can be purchased via the Mind Garden website.
Burnout Self-Test
The Burnout Self-Test is an online test to check if one is experiencing burnout. [21] The test has not been tested for validity and reliability and therefore not to be used as a diagnostic measure of burnout. The test has 15 items scored on a five-point Likert scale, ranging from not at all to very often. Higher scores indicate burnout.
The Burnout Self-Test is available from Mind Tools free of charge:
https://www.mindtools.com/auhx7b3/burnout-self-test
Brief Resilience Scale
The Brief Resilience Scale (BRS) is a measure of the ability to bounce back or recover after a stressful situation. [3] The BRS was found to be a reliable measure of resilience. It has six items scored on a five-point Likert scale, ranging from strongly disagree to strongly agree. Higher scores indicate higher resilience.
Copies of the BRS can be used free of charge and available in the What Works Wellbeing website:
https://measure.whatworkswellbeing.org/measures-bank/brief-resilience-scale/
Conclusion
There are many existing tools with good validity and reliability that organisations and individuals can use to assess if burnout levels are increasing in the aged care workforce. Of note, choice of tools will depend not only on the validity and reliability of the tools but also on the burnout components or subscales of interest. This is important so that strategies to prevent and address burnout can be prioritised, tailored, and implemented as early as possible, particularly in the workplace setting.
We note that there are only a few tools available that have been used in research studies to measure burnout among Australian aged care workers. This is due to limited research and projects that investigated burnout levels of the Australian aged care workforce.
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