Burnout in the nursing home health care aide: A systematic review

• Individual and organizational factors precipitate or buffer HCA burnout.
• Individual buffers of burnout focus on subjective appraisal of work environment.
• Organizational factors that increase time to complete tasks precipitate burnout.
• Identified interventions are primarily educational programs of limited utility.
• Research should investigate causal relationships between factors affecting burnout.

ObjectiveTo systematically review the evidence on factors that influence burnout in health care aides working in nursing homes.DesignSystematic literature review.Data sourcesTwo search engines (Google and EBSCO Discovery Service) and five databases (MEDLINE, Scopus, CINAHL, PsycINFO and Proquest Dissertations & Theses) through to August 2013. Keywords: nursing home, health care aide and burnout (all synonyms were included).MethodsTwo authors independently assessed methodological quality, data extraction, analysis and synthesis on the 10 included publications. 100% reliability was found between the first and second authors. Data extracted included precipitating and buffering factors related to burnout, interventions and demographic information for the health care aide population. Data were synthesized according to individual and organizational factors.ResultsOur search and screening yielded 2787 titles and abstracts resulting in 83 manuscripts for full manuscript review and 10 included publications. Methodological quality assessments revealed 3 (30%) rated as low quality, 7 (70%) rated as medium quality. Independent variables were categorized as either individual or organizational factors. Methodological problems and heterogeneity in independent and dependant variables yielded few significant results. Only personal life (attributes of provider) was found to significantly buffer burnout (depersonalization, emotional exhaustion and personal accomplishment). Equivocal evidence was found for many of the organizational factors (work environment, workload and facility) supporting the need for further robust studies in this field. Of the two intervention studies, only dementia care mapping, and training in organizational respect buffered burnout.ConclusionFactors associated with burnout in health care aides are similar to those reported among nurses, although the level of evidence and low methodological rigor of these studies suggest more robust study designs are warranted. Our findings suggest research focused on this important but largely invisible group of care providers could yield important advances in understanding burnout in this group and yield potential interventions to buffer burnout and its consequences. Without mitigating the effects of burnout on nursing home health care aides, vulnerable older adults in residential care are at risk.