Burnout and Adherence to Pressure Injury Prevention Guidelines Among ICU Nurses in a Teaching Referral Hospital

Chiyar Edison Sunarya

doi:10.19166/ncjk.v14i1.10907

Authors

Chiyar Edison Sunarya Faculty of Nursing Universitas Indonesia

DOI:

https://doi.org/10.19166/ncjk.v14i1.10907

Keywords:

Burnout, Intensive Care Unit, pressure ulcer

Abstract

Burnout is a major problem among intensive care nurses, yet its relationship with pressure injury prevention adherence has not been examined within the Indonesian context. This study aimed to determine the association between burnout levels and adherence to pressure injury prevention guidelines among nurses working in intensive care units of a type-A teaching hospital. A cross-sectional study was conducted among 144 ICU nurses in a teaching referral hospital in Depok. Data were collected using the Questionnaire for Adherence to Recommendations for Pressure Ulcer Prevention (QARPPU) and the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Univariate analyses summarized respondent characteristics, and chi-square tests with Cramer’s V examined the association between burnout and adherence.It is revealed that most nurses showed adequate adherence to pressure injury prevention practices (58.3%). High burnout was evident in 45.8% of respondents. There was a strong statistical association between burnout level and the adherence of prevention of pressure ulcers (χ² = 27.65, p < 0.001), with a moderate effect size (Cramer’s V = 0.438). Burnout was significantly associated with adherence to pressure injury prevention guidelines among intensive care nurses. Although high burnout prevalence was comparatively lower, this is still an important issue to be solved by hospital management.

References

Alzahrani, H. M., Alanazi, E. F., & Almutairi, S. M. (2024). Burnout among nurses in Intensive Care Unit in Saudi Arabia: implications for nursing management. British Journal of Nursing Studies, 4(2), 01-09. DOI: https://doi.org/10.32996/bjns.2024.4.2.1

Amir, Y., Lohrmann, C., Halfens, R. J. G., & Schols, J. M. G. A. (2017). Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. International Wound Journal, 14(1), 184-193. DOI: https://doi.org/10.1111/iwj.12580

Amir, Y., Tan, F. E., Halfens, R., Lohrmann, C., & Schols, J. (2017). Pressure Ulcer Prevalence and Care in Indonesian Hospitals: A Multicenter, Cross-sectional Evaluation Using an Extended Donabedian Model. Ostomy/wound management, 63(2), 8-23. DOI: https://europepmc.org/article/med/28267680

Daryanto, B., Putri, F. R., Kurniawan, J., Ilmawan, M., & Fajar, J. K. (2022). The prevalence and the associated sociodemographic-occupational factors of professional burnout among health professionals during COVID-19 pandemic in Malang, Indonesia: a Cross-sectional study. Frontiers in Public Health, 10, 894946. DOI: https://doi.org/10.3389/fpubh.2022.894946

Efendi, D., Tan, A., Utomo, B., Edison, C., Chung, M.-H., Muslih, M., . . . Rukmana, A. (2025). Cross-cultural adaptation and psychometric validation of the Indonesian questionnaire for evaluating nurses' adherence to pressure ulcer prevention guidelines. Applied Nursing Research, 151962. DOI: https://doi.org/10.1016/j.apnr.2025.151962

Ghazanfari, M. J., Karkhah, S., Maroufizadeh, S., Fast, O., Jafaraghaee, F., Gholampour, M. H., & Zeydi, A. E. (2022). Knowledge, attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study. Journal of Tissue Viability, 31(2), 326-331. DOI: https://doi.org/10.1016/j.jtv.2022.01.009

Grešš Halász, B., Bérešová, A., Tkáčová, Ľ., Magurová, D., & Lizáková, Ľ. (2021). Nurses’ knowledge and attitudes towards prevention of pressure ulcers. International Journal of Environmental Research and Public Health, 18(4), 1705. DOI: https://www.mdpi.com/1660-4601/18/4/1705#

He, M., Tang, A., Ge, X., & Zheng, J. (2016). Pressure ulcers in the intensive care unit: an analysis of skin barrier risk factors. Advances in skin & wound care, 29(11), 493-498. DOI: 10.1097/01.ASW.0000494779.66288.c9

Juanamasta, I. G., Aungsuroch, Y., Gunawan, J., Dino, M. J., & Polsook, R. (2024). Prevalence of burnout and its determinants among Indonesian nurses: a multicentre study. Scientific reports, 14(1), 31559. DOI: https://doi.org/10.1038/s41598-024-63550-6

Khojastehfar, S., Ghezeljeh, T. N., & Haghani, S. (2020). Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study. Journal of Tissue Viability, 29(2), 76-81. DOI: https://doi.org/10.1016/j.jtv.2020.02.002

Kotb Basuony, A. E., Zahran, S. A. E.-M., & Eid, W. M. (2023). Relation between Occupational Hazards and Nurses’ Job Burnout at Intensive Care Units. Tanta Scientific Nursing Journal, 30(3), 83-97.

Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., & Shanafelt, T. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: a systematic review and meta-analysis. JAMA network open, 7(11), e2443059-e2443059. DOI: 10.1001/jamanetworkopen.2024.43059

Mallah, Z., Nassar, N., & Badr, L. K. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Applied Nursing Research, 28(2), 106-113. DOI: https://doi.org/10.1016/j.apnr.2014.07.001

Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach burnout inventory: Scarecrow Education.

Masyitha, K., & Puspita, D. (2020). Pressure ulcers related to medical device in intensive care in Indonesia: A prospective study. Enfermería Clínica, 30, 87-91. DOI: https://doi.org/10.1016/j.enfcli.2020.01.006

Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881-890. DOI: https://doi.org/10.1016/j.jaad.2018.12.069

Montenegro Méndez, S., Laguía González, A., & Moriano León, J. A. (2025). Is Leadership a Resource? A Systematic Review of Its Role in Burnout and Engagement Among Nurses Within the JD‐R Model. Journal of Nursing Management, 2025(1), 8853148. DOI: https://doi.org/10.1155/jonm/8853148

Moya-Suárez, A. B., Morales-Asencio, J. M., Aranda-Gallardo, M., de Luna-Rodríguez, M. E., & Canca-Sánchez, J. C. (2017). Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU). Journal of Tissue Viability, 26(4), 260-270. DOI: https://doi.org/10.1016/j.jtv.2017.09.003

Papazian, L., Hraiech, S., Loundou, A., Herridge, M. S., & Boyer, L. (2023). High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis. Intensive care medicine, 49(4), 387-400. DOI: https://doi.org/10.1007/s00134-023-07025-8

Pappa, D., & Dafogianni, C. (2020). Association of occupational burnout and nursing errors with patient safety: A systemic review. International Journal of Reliable and Quality E-Healthcare (IJRQEH), 9(4), 18-29. DOI: 10.4018/IJRQEH.2020100104

Ramírez-Elvira, S., Romero-Bejar, J. L., Suleiman-Martos, N., Gomez-Urquiza, J. L., Monsalve-Reyes, C., Canadas-De la Fuente, G. A., & Albendin-Garcia, L. (2021). Prevalence, risk factors and burnout levels in intensive care unit nurses: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(21), 11432. DOI: https://doi.org/10.3390/ijerph182111432

Sari, S. P., Everink, I. H., Sari, E. A., Afriandi, I., Amir, Y., Lohrmann, C., . . . Schols, J. M. (2019). The prevalence of pressure ulcers in community‐dwelling older adults: a study in an Indonesian city. International Wound Journal, 16(2), 534-541. DOI: https://doi.org/10.1111/iwj.13081

Sayrafi, N. A., Salami, A., & Ghssein, G. (2024). Impact of Effort–Reward Imbalance and Burnout on the Compliance with Standard Precautions among Nurses and Midwives in Lebanese Hospitals. Nursing Reports, 14(2), 1477-1493. DOI: https://doi.org/10.3390/nursrep14020111

Stadnyk, B., Mordoch, E., & Martin, D. (2018). Factors in facilitating an organisational culture to prevent pressure ulcers among older adults in health-care facilities. Journal of wound care, 27(Sup7), S4-S10. DOI: https://doi.org/10.12968/jowc.2018.27.Sup7.S4

Tayyib, N., Coyer, F., & Lewis, P. A. (2016). Implementing a pressure ulcer prevention bundle in an adult intensive care. Intensive and Critical Care Nursing, 37, 27-36. DOI: https://doi.org/10.1016/j.iccn.2016.04.005

Tesema, H. G., Lema, G. F., Mesfin, N., Fentie, D. Y., & Arefayne, N. R. (2021). Patterns of admission and clinical outcomes among patients admitted to medical intensive care unit of a teaching and referral hospital, Northwest Ethiopia. Global advances in health and medicine, 10, 2164956121989258. DOI: https://doi.org/10.1177/2164956121989258

Yakupu, A., Wang, H., Huang, L., Zhou, J., Wu, F., Lu, Y., & Lu, S. (2022). Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer from 1990 to 2019: a systematic analysis for the global burden of disease 2019. The International Journal of Lower Extremity Wounds, 15347346221092265. DOI: https://doi.org/10.1177/15347346221092265

Yestiana, Y., Kurniati, T., & Hidayat, A. A. A. (2019). Predictors of burnout in nurses working in inpatient rooms at a public hospital in Indonesia. Pan African Medical Journal, 33(1). https://www.ajol.info/index.php/pamj/article/view/211023