الفهرس 
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Abstract
Covid-19 pandemic is considered one of the most infectious disease that greatly
affected health care workers, especially critical care nurses, who were on the frontlines of
facing the pandemic and which have increased their burnout. Burnout is a common problem
among healthcare workers, and the pandemic has exacerbated this issue. Critical care nurses
have the responsibility of caring for critically ill patients and who often work for long hours in
stressful and emotionally challenging environment. During the outbreak, ICU nurses faced
unprecedented challenges, including nursing shortages, high patient numbers, and the risk of
contracting the virus and transmitting it to their families.
To address burnout among critical care nurses, healthcare organizations have developed
and carried out a variety of strategies, including providing access to mental health resources,
offering groups support, counseling services, and providing training and education on stress
management techniques. Additionally, addressing the root causes of burnout, such as
workload and staffing issues, can prevent burnout from occurring.
It is important to understand the crucial role that ICU nurses play in managing and
caring for patients and to provide them with the support and resources they need to maintain
their physical and emotional well- being during the pandemic and beyond. Therefore, the
aims of this study are ”to determine critical care nurses‘ burnout during the outbreak of
Covid-19 in Alexandria – Egypt, and to identify factors associated with critical care nurses‘
burnout during the outbreak of COVID-19 in Alexandria – Egypt”.
Material & Method
A descriptive research design was used in this study. Data was collected from the
intensive care units of the following hospitals: ”Alexandria New University Hospital
(ANUH)” (18 nurses), Health Affairs Directorate Hospitals: Alexandria Fever Hospital (22
nurses), Kom El-Shoqafa Chest Hospital (30 nurses), AL Maamoura Chest Hospital (30
nurses), and El Agamy General Hospital (30 nurses). All the previously mentioned hospitals
were dedicated for the care and management of COVID-19 patients only.
A convenience sample of all nurses working in the intensive care units of the abovementioned
settings (Approximately 130 nurses) and providing direct care for COVID-19
patients, and willing to participate were included in this study.
To accomplish the aim of the current study: two tools were used to collect the data in
this study: Tool one: ―The Copenhagen burnout inventory (CBI)‖: The Copenhagen Burnout
Inventory is adopted from (Kristensen et al., 2005). This tool is used to measure critical care
nurse‘s burnout. It is a 19-items consisting of three separate scales namely personal-related
burnout, work-related burnout, and client-related burnout.
Personal-related burnout, this scale consists of 6 questions with response categories as
follows: Always category with score of 100, often category with75 as a score, sometimes category
with a score of 50, seldom category with score of 25, and never/almost never category with 0 as a
score. The total score was the average of the score on the items. If the participant gave answers to
less than three questions, the respondent was classified as non-responder.
Work-related burnout, this scale consists of 7 questions with response categories as
follows: the first three questions: ”a very high degree, to a high degree, Somewhat, a low
degree, To a very low degree”. The last four questions: ”Always, Often, Sometimes, Seldom,
Never/almost never”. Reversed score for last question. Scoring as for the first scale.
Client-related burnout, this scale consists of 6 questions with response categories as
follows: The first four questions: ”to a very high degree, to a high degree, somewhat, to a low
degree, to a very low degree”. The last two questions: ”Always, Often, Sometimes, Seldom,
Never/almost never”. Scoring as for the first two scales. The responder was classified as a
non-responder if they had answered less than three questions. Items were measured using
five-category responses. The specific categories were: ”Never/almost never, seldom,
sometimes, often, and always for 12 of the items”, and: ”to a very low degree, to a low degree,
somewhat, to a high degree, and to a very high degree” for the other 7 items. Only one item,
which appears on the work-related burnout scale, uses reverse scoring. The calculated score of
scales indicates the presence of burnout if it amounts to higher than 50 points, Scores of 50 to
74 were considered ‗moderate‘,75–99 were considered high, and a score of 100 was
considered as severe burnout.
Tool two: Factors associated with critical care nurses’ burnout assessment tool”
This tool was used to assess factors associated with ICU nurses‘ burnout. It consists of 3
parts: Fear of COVID-19 infection, hospital resources, and family and friends support.
Part I: Fear of COVID-19 infection
This part was utilized to evaluate the psychological consequences of fear and stress as
well as the degree of COVID-19 resilience. This scale is adopted from (Tzeng & Yin, 2006) a
high score means a high fear of covid-19 infection.
Part II: Hospital resources:
This part was used to measure hospital resources which is available for the treatment of
COVID-19. It is adopted from (Kim & Choi, 2016), a high score indicates that the hospital
resources are satisfactory for the treatment of COVID-19. Cronbach α of this scale was 0.81.
Part III: Family support
This part was used to measure the support received from family and friends. It is
adopted from (Kim & Choi, 2016). A high score indicates that the respondent has had enough
family support. Cronbach α of this scale is 0.80.
Method
An official letter from the Faculty of Nursing, Alexandria University was submitted to
the responsible authorities of the study settings to obtain permission to collect the necessary
data after explaining the purpose of the study, Permissions were obtained from the Ministry of
Health and population in Cairo and permission from the general manager of each hospital to
collect data from the hospitals of the Directorate of Health Affairs, and Alexandria New University Hospital (ANUH).
Data collection
All nurses working in the previously mentioned units and meeting the inclusion criteria were
enrolled in the study.
Data of the current study were collected through a structured interview conducted with
nurses during their break time and/or after terminating their shift in a separate room and
outside the ICU. Each nurse was interviewed individually after explaining the aim of the
study. Each interview took approximately 15 minutes to complete.
The researcher has spent 10 days in each hospital to collect the data from all ICU nurses
working with COVID-19 patients during the three shifts of the day (morning, evening,
and night), in nurses room at the end of each shift.
Data collection took approximately 50 days to complete from the five hospitals starting
from July 2021 to February 2022.
Results
The present study illustrated that age of the study participants ranged from 18 to 45 years
old, and the majority of them were females. The majority of the ICU nurses had the presence
of an elderly person in their family.
It was noticed that more than half of the participants had a high level of personal-related
burnout. On the other hand, more than one-half of ICU nurses had a moderate level of workrelated
burnout. Furthermore, more than two-fifths of ICU nurses had a moderate level of
client-related burnout.
Results revealed that about half of subjects had a moderate level of fear of being
COVID-19 positive, and more than half of critical care nurse‘s experienced a severe level of
fear of being positive.
As regards hospital resources, more than two-thirds 66.2% of critical care nurses were not
satisfied with hospital resources, while 33.8% were satisfied with the hospital resources and about
three-quarters 75.4% of critical care nurses received low support from family and friends.
The significant predictors were number of 4 patients assigned per shift 66.7% of the
study participants had severe level of burnout more than number of 3 patients assigned per
shift 63.6% of the study participants had moderate level of burnout.
The significant predictors were sex; female burnout score is higher than males by 3.91 units
p=.033; fear of COVID19 infection; as fear increased, the burnout score increased by 5.8 units
p.001; and the presence of elderly people in the family increases burnout by 4.9 units p=.045.
The significant predictors of personal-related burnout were the female burnout score is
higher than males by 6.32 units p=.003; fear of COVID19 infection; as fear increased, the
burnout score increased by 6.1 units p.001; night working system p=.025; and regarding the
years of experience; as years of experience increased, the burnout score increased by.477
units (p=.019).
The significant predictors of wok-related burnout were age p=.012 as with each increase
of 1 year, the burnout score increases by 0.461 units; Regarding sex, females’ burnout score is
higher than males’ by 5.25 units p=.013; Other shift working system is 6 hours working shift
with p=.021; and fear of COVID19 infection. As fear increased, the burnout score increased
by 4.7 units p.001.
which are 6 hours shift with p=.046, fear of COVID19 infection, as fear increases, the burnout
score increases by 6.5 units p.00.1.
Conclusion
Based on the findings of the current study, it can be concluded that critical care nurses were
experiencing burnout during the outbreak of COVID-19 in Alexandria, Egypt. Most of critical
care nurses had a high level of personal-related burnout and a moderate level of work- related
burnout while a lesser percent of them had a moderate level of client- related burnout, during the
outbreak. Age, gender, presence of an elderly person, work system, fear of the coronavirus,
number of patients assigned to shifts and hospital vacation system are among the factors that
played a role in nurses’ burnout during the outbreak of, COVID-19 in Alexandria, Egypt.
Recommendations
Encourage critical care nurses with high level of burnout to attend group therapy
sessions directed by advanced practitioners to improve nurses‘ performance.
Inform the public about the necessity of reducing the stigmatization of nurses working
in pandemic settings.
Develop stress management programs to prevent and treat psychological distress
among frontline workers during the COVID-19 pandemic.
Apply this study on a larger sample size, and from different health care organization
ICUs settings.