Emotional exhaustion in nursing students. A multicenter study

Cross-sectional, correlational study, carried out in Chile and Spain (2017-2018), with 1,368 students answering a self-applied instrument (sociodemographic/academic variables and the Emotional Exhaustion scale). Analysis with Stata 15, according to variables: Chi² tests, Wilcoxon rank sum test (Mann Whitney U test), analysis of variance and multiple regression; confidence level 95% and significance 5% (p < 0.05). Approved by the Ethics Committee, Universidad de Girona.

Results:

Academic variables and perceived stress with Quite Much/Much classification: Exams, Problem-Based Learning, Laboratory/Simulation. Statistically significant differences in emotional exhaustion, according to sex, dependent people, workers, commuting time >30 minutes. Greater emotional exhaustion when taking courses for the second time and in academic activities where they declare perceived stress as Quite Much/Much (p < 0.005).

Conclusion:

All students present mean level of emotional exhaustion (>26 and <37 points). The variables sex and having dependents are relevant aspects. Stress perceived by methodologies is significantly related to levels of emotional exhaustion.

DESCRIPTORS
Students, Nursing; Multicenter Study; Stress, Psychological; Education, Nursing

		UdL		URV		UdG		UFRO		Total
		n	%	n	%	n	%	n	%	n	%
Sex	Female	255	81.5	401	84.6	335	86.8	126	78.7	1117	83.8
Sex	Male	58	18.5	73	15.4	51	13.2	34	21.3	216	16.2
Age*	≤ 20	99	31.1	140	28.7	196	51.2	58	35.8	493	36.5
	21–24	166	52.2	256	33.9	130	33.9	91	56.2	693	47.6
	25–28	32	10.1	51	9.4	36	9.4	8	4.94	127	9.4
	>29	21	6.6	41	8.4	21	5.5	5	3.1	88	6.51
Marital status	Single	279	86.9	409	84.5	336	87.5	156	95.7	1180	87.3
	Married	7	2.1	16	3.3	9	2.3	2	1.2	34	2.5
	Common-law marriage	32	10.0	57	11.8	38	9.9	4	2.5	131	9.7
	Divorced	3	0.9	2	0.4	1	0.3	1	0.6	7	0.5
Dependents	If any	5	1.6	12	2.5	1	0.3	3	1.9	21	1.6
Dependents	Do not have	315	98.4	469	97.5	380	99.7	158	98.1	1322	98.4
Works	Yes	112	34.8	126	25.6	163	42.5	32	19.7	433	31.8
Works	No	210	65.2	367	74.4	221	57.5	130	80.3	928	68.2
Commuting time	≤30 minutes	281	90.1	416	86.3	261	69.4	105	64.4	1063	79.7
Commuting time	>30	31	9.9	66	13.7	115	30.6	58	35.6	270	20.3
Financing system	Own	56	17.4	82	16.6	99	25.8	10	6.1	247	18.1
	Family	222	68.7	339	68.8	218	56.8	67	41.4	846	62.1
	Mixed	45	13.9	72	14.6	67	17.5	85	52.5	269	19.8
Scholarship*	Yes	153	47.4	276	55.9	207	53.6	103	63.6	739	54.1
Scholarship*	No	170	52.6	218	44.1	179	46.4	59	36.4	626	45.9
Students per Course*	First	91	28.5	167	34.0	123	31.8	43	26.7	424	31.2
	Second	92	28.9	188	38.3	98	25.3	26	16.1	404	29.8
	Third	83	26.0	96	19.6	113	29.2	74	46.0	366	26.9
	Fourth	53	16.6	40	8.1	53	13.7	18	11.2	164	12.1
Disciplines enrolled for the second time*	Yes	53	17.0	122	27.1	68	18.5	24	16.7	267	21.0
Disciplines enrolled for the second time*	No	259	83.0	329	72.9	299	81.5	120	83.3	1007	79.0
Contact clinical practices*	Yes	315	98.1	357	73.0	264	68.2	152	93.3	1088	80.0
Contact clinical practices*	No	6	1.9	132	27.0	123	31.8	11	6.7	272	20.0

Academic activities	Perceived stress level	UdL		URV		UdG		UFRO		Total
Academic activities	Perceived stress level	n	%	n	%	n	%	n	%	n	%
Master class*	N/L	258	80.4	404	81.8	288	74.4	150	92.6	1100	80.6
Master class*	QM/M	63	19.6	90	18.2	99	25.6	12	7.4	264	19.4
Seminar*	N/L	132	41.0	336	68.2	218	56.3	96	61.5	782	57.6
Seminar*	QM/M	190	59.0	157	31.8	169	43.7	60	38.5	576	42.4
PBL*	N/L	129	53.5	183	37.1	80	20.7	92	57.1	484	37.8
PBL*	QM/M	112	46.5	310	62.9	306	79.3	69	42.9	797	62.2
Laboratory/simulation*	N/L	78	24.4	312	63.4	156	41.5	98	60.9	644	47.7
Laboratory/simulation*	QM/M	242	75.6	180	36.6	220	58.5	63	39.1	705	52.3
Clinical practices*	N/L	167	52.2	216	45.6	188	53.3	25	15.6	596	45.6
Clinical practices*	QM/M	153	47.8	258	54.4	165	46.7	135	84.4	711	54.4
Team work*	N/L	176	54.5	201	40.7	185	47.8	85	52.5	647	47.4
Team work*	QM/M	147	45.5	293	59.3	202	52.2	77	47.5	719	52.6
Exams/tests*	N/L	13	4.0	35	7.1	20	5.2	26	16.1	94	6.9
Exams/tests*	QM/M	310	96.0	459	92.9	365	94.8	136	83.9	1270	93.1
Written work*	N/L	103	32.0	158	32.1	140	36.2	84	51.8	485	35.6
Written work*	QM/M	219	68.0	335	67.9	247	63.8	78	48.2	879	64.4
Oral presentation	N/L	74	23.0	90	18.2	80	20.7	31	19.1	275	20.2
Oral presentation	QM/M	248	77.0	404	81.8	306	79.3	131	80.9	1089	79.8

	EES score			Difference among means
University	Mean score	SD	Absolute frequency	UdL	URV	UdG
UdL	30.3	8.1	316
URV	30.6	7.9	485	0.35 (p = 1.00)
UdG	32.3	8.1	369	2.07 (p = 0.004)	1.7 (p = 0.011)
UFRO	32.5	7.8	155	2.23 (p = 0.025)	1.9 (p = 0.061)	0.16 (p = 1.00)
Total	31.2	8.0	1325

		Global emotional exhaustion level
Sociodemographic variables	Category	n	Mean	SD
Sex	Male	214	27.9*	8.8
Sex	Female	1077	31.9	7.8
Age	≤20	493	31.6	8.1
	21–24	643	31.0	8.0
	25–28	127	31.9	8.0
	≥29	88	30.1	7.9
Dependents	Yes	36	35.7	8.0
Dependents	No	1071	30.9*	8.0
Works	Yes	428	32.1	8.0
Works	No	892	30.8*	8.1
Commuting time	<30 minutes	1034	30.9*	8.1
Commuting time	>30 minutes	259	32.7	7.4
Scholarship	Yes	719	31.9	7.9
Scholarship	No	604	30.5*	8.1
Academic variable	Category	n	Mean	SD
Course	First	407	31.1	8.0
	Second	397	32.1	8.1
	Third	353	31.7	8.2
	Fourth	159	28.6*	7.1
Disciplines enrolled for the second time	Yes	259	32.5*	8.3
Disciplines enrolled for the second time	No	979	30.8	7.8
Practice contact	Yes	1057	31.4	8.0
Practice contact	No	261	30.8	8.0
Academic activity	Perceived stress	n	Mean	SD
Master class	None/Little	1067	30.4*	7.9
Master class	Quite Much/Much	255	35.0	7.7
Seminar	None/Little	761	29.4*	7.9
Seminar	Quite Much/Much	555	33.7	7.5
Problem-based learning	None/Little	470	29.2*	7.9
Problem-based learning	Quite Much/Much	773	32.6	7.8
Laboratory/simulation	None/Little	624	30.0*	8.2
Laboratory/simulation	Quite Much/Much	686	32.3	7.8
Clinical practices	None/Little	581	29.7*	8.3
Clinical practices	Quite Much/Much	689	32.4	7.5
Team work	None/Little	624	29.5*	8.2
Team work	Quite Much/Much	700	32.8	7.5
Exams/tests	None/Little	92	23.4*	8.2
Exams/tests	Quite Much/Much	1230	31.8	7.7
Written work	None/Little	467	28.2*	8.0
Written work	Quite Much/Much	855	32.9	7.6
Oral presentation	None/Little	268	28.9*	8.9
Oral presentation	Quite Much/Much	1054	31.8	7.7

EES total	Coef.	Std. err.	t	P >\|t\|	[95% Conf. Interval]
Sex	–1.682	0.588	–2.86	0.004*	–2.836 –0.528
Dependents	3.691	1.749	2.11	0.035*	0.261 7.123
Works	–0.519	0.483	–1.07	0.283	–1.467 0.430
Stress level (SL) class classes	3.578	0.565	3.18	0.002*	0.400 1.691
Seminar SL	1.633	0.465	3.51	0.011*	0.263 2.052
PBL SL	1.157	0.456	2.54	0.005*	0.243 1.329
Practices SL	2.206	0.435	5.07	0.000*	1.352 3.060
Group work SL	1.755	0.440	3.99	0.000*	0.891 2.619
Exams SL	6.570	0.835	7.86	0.000*	4.930 8.209
Written work SL	2.221	0.466	4.76	0.000*	1.306 3.136
Age
21–24	–0.267	0.479	–0.56	0.577	–1.206 0.672
25–28	–0.567	0.780	–0.73	0.467	–2.097 0.962
≥29	–2.004	0.994	–2.02	0.044*	–3.954 –0.053
Commuting time (30 minutes)	1.710	0.530	3.23	0.001*	0.670 2.750
Cons	–2.251	3.128	–0.72	0.472	–8.389 3.887

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E-mail: reeusp@usp.br

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[1] Corresponding author: Ximena Osorio-Spuler Manuel Montt, 112 Temuco, Chile ximena.osorio@ufrontera.cl