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Open Access

Original Article

Relationship of anxiety and burnout with
extrasystoles in critical care nurses in Turkey
Yildiz Denat1, Serap Gokce2, Hasan Gungor3,
Cemil Zencir4, Cagdas Akgullu5
Objective: To determine the relationship between levels of anxiety and burnout and prevalence of atrial
extrasystoles (AESs) and ventricular extrasystoles (VESs) among critical care nurses.
Methods: The sample of study included 51 nurses who worked in the intensive care units of a university
hospital located in western Turkey. Beck’s Anxiety Inventory and the Maslach Burnout Inventory were used
in the study.
Results: The mean emotional exhaustion score of the nurses was 14.68±6.10, the mean personal
accomplishment score was 19.19±7.08, the mean depersonalization score was 5.31±3.84 and the mean
anxiety score was 12.37±11.12. The rates of VESs and AESs detected in the critical care nurses were
21.6% and 35.3%, respectively. No relationship was found between levels of anxiety and burnout and the
prevalence of AESs and VESs among the critical care nurses. A positive correlation was found between
personal accomplishment scores and numbers of VESs (r= 0.693, p=0.001) and AESs (r= 0.700, p= 0.001).
Conclusion: In the present study, there were low mean scores of burnout and anxiety among nurses
working in intensive care units. No relationship was found between levels of anxiety and burnout and the
prevalence of AESs and VESs among nurses who work in intensive care units. It was found that the people
feeling more personal accomplishment have more VES or AES. The prevalence of AESs and VESs among the
critical care nurses suffering from burnout and anxiety may be studied in the future studies.
KEY WORDS: Anxiety, Burnout, Critical Care, Extrasystoles, Nursing.
How to cite this:
Denat Y, Gokce S, Gungor H, Zencir C, Akgullu C. Relationship of anxiety and burnout with extrasystoles in critical care nurses in
Turkey. Pak J Med Sci. 2016;32(1):196-200. doi:
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Yildiz Denat, PhD. INTRODUCTION
Assistant Professor,
2. Serap Gokce, PhD.
Research Assistant,
Burnout syndrome and anxiety are common,
3. Hasan Gungor, MD, important problems for health workers, which
Associate Professor of Cardiology, have received increasing attention during recent
4. Cemil Zencir, MD,
Assistant Professor of Cardiology, years.1,2 Burnout has been defined as a particular
5. Cagdas Akgullu, MD, type of work stress in professionals who provide
Associate Professor of Cardiology
1, 2: Adnan Menderes University, services to people, which results from the difficult
Aydin School of Health, and emotionally charged relationships between
09100, Aydin, Turkey.
3-5: Adnan Menderes University,
providers and receivers of care.3 Meanwhile,
Department of Cardiology, anxiety is a diffuse and usually vague sense of
09100, Aydin, Turkey. apprehension, accompanied by various unpleasant
Correspondence: physical sensations. Some studies emphasize
Yildiz Denat, that that nurses are at a high risk of developing
E-mail: anxiety and that nurses try to cope with chronic
* Received for Publication: June 25, 2015 stress they are being exposed to by developing
* Revision Received: Ocotber 24, 2015 defense mechanisms and sometimes these defense
* Revision Accepted: November 5, 2015 mechanisms and anxiety/depression experiences

196 Pak J Med Sci 2016 Vol. 32 No. 1

32 No. which may result in heartbeats in healthy hearts is limited.22-23 The scale consists of 22 questions.79). Beck’s Anxiety Inventory (BAI) and the In a study by Toker et al. departments. However. cardiovascular risk factors such as dislipidemia Data were collected using an information and other metabolic syndrome components. especially atrial and ventricular by Maslach and Jackson.91. Based on this evidence. Therefore. It has been of 1114 patients in China found a relationship reported that sometimes these defense mechanisms between anxiety symptoms and prevalence and anxiety reach pathological dimensions in their of extra ventricular 197 .19 However. as low In clinical practice. information about experienced higher levels of burnout had a higher working conditions and levels of satisfaction with risk (HR=1.14 Other evidence antidepressants or antiarrhythmic agents when supports a relationship between burnout and they were included in the study. Higher total scores obtained from the close monitoring of their cardiovascular health and inventory indicate the severity of the anxiety that taking the necessary precautions at an early stage is the individual experiences. aimed to investigate the relationship between levels depersonalization and a perceived reduction in of anxiety and burnout and the prevalence of atrial personal accomplishment. High scores on infection and fever is generally recommended. it has been the intensive care unit.4-6 In a study by Turnipseed7. hyperthyroidism. anxiety. anemia. emotional exhaustion (EE). health and may be accepted as a risk factor for had no active infection or fever. in addition to examining is rated between 0 and 3 based on the response cases of anxiety and burnout in critical care nurses.16 It can be seen that the Beck’s Anxiety Inventory (BAI) was developed cardiac health of nurses. or Burnout has been defined as a syndrome Turkish critical care nurses in particular.80.8.pjms.9 Many studies have demonstrated that METHODS burnout is high among critical care nurses and This study was conducted in the intensive care report their symptoms of burnout. particularly critical care by Beck et al.. DP. options. it was burnout.4 times greater of information form included demographic risk of coronary heart disease and that those who characteristics. are generally considered benign Turkish and its reliability recalculated by Ergin in healthy individuals without structural heart and Cam. regards to stress. cardiovascular symptoms and the found that anxiety and burnout were related.20 and Turkish reliability and validity nurses. who work in stressful environments. the important both to increase the quality of care and Cronbach’s alpha reliability coefficient for the to improve the health of nurses working in these Anxiety Inventory was 0. and was not using physical diseases and morbidity. hyperthyroidism or asthma. of nurses working in departments with high levels of stress.15 it was found that Maslach Burnout Inventory (MBI). and personal accomplishment (PA).21 be at risk due to their high experience of burnout It is a Likert-type scale with 21 items. and treatment of secondary causes such as stress.3 One section burnout was associated with a 1. Maslach Burnout Inventory (MBI) was developed Arrhythmias. Anxiety & burnout in critical care nurses reach pathological dimensions. This study which includes emotional exhaustion. A study the development of burnout syndrome. coronary heart disease. depersonalization (DP) anxiety. the evaluation The scale measures three components of burnout. and 0.85. relationship between them in critical care nurses. each item and anxiety. hypoxia. The study sample consisted of 51 critical negative effect on quality of life and mental health care nurses who were not diagnosed with structural and that burnout has a negative effect on physical heart disease. may studies of the scale were made by Ulusoy et al. in cases like these. are investigated with Cronbach’s alpha reliability coefficients for EE. Burnout syndrome has extrasystoles (AESs) and ventricular extrasystoles a significant effect on the health and job efficiency (VESs) among critical care nurses.18 the EE or DP subscales indicates burnout. anemia. The other section included suggested that burnout may be a risk factor for records of their cardiac investigations. 0. In the present study. which scores on the PS subscale.20-21 In our study.94. Pak J Med Sci 2016 Vol. 1 www. However. include premature heartbeats. these the number of studies and PA were 0. evaluating the relationship between levels of All echocardiographic (ECHO) studies were anxiety and burnout and extra atrial and ventricular obtained using a Vivid 5 (General Electric. educational level. respectively.9-13 units of a university hospital located in western Research to date has shown that burnout has a Turkey. disease. no lives and may lead to the development of burnout studies have been found which aim to investigate syndrome.3 It was first translated into arrhythmias.14-17 form.

2% were No 4 (7. 16.7) Whitney U test was used to detect any significant Education differences between nurses with and without Vocational school degree 12 (23.3) care and 70.19±7.5) scores.8) shift workers.05.7% stated that they had willingly selected their during working hours profession and 51% would not consider changing 2-3 patients 39 (76. Since Female 44 (86. VESs were detected Are you competent in patient care? in 21.6) No statistically significant difference was found Are you satisfied with your work life? between the burnout scores of nurses with and Satisfied 15 (29.4% declared Did you choose your profession willingly? that they believed they were competent in patient Yes 19 (37. scores of nurses with and without AESs (p>0. WI. 92. Do you think changing your profession? In the analysis of burnout and anxiety scores.09±6.68±6.0) mean EE score was 14. The study was number of VESs and AESs (p<0. 78. 56. The number of patients to be responsible 62.7) work life (Table-I).08.26 years. 78. mean DP score was 5.9% were working 40 hours per Yes 47 (92.5% were permanent staff.9) was accepted at the level of p <0. socio-demographic characteristics.4) without VESs (p>0.5) AESs/VESs in terms of mean Burnout and Anxiety Bachelor’s degree 39 (76. Partially competent 11 (21. All participants were evaluated by the nurses.3) the data were non-normally distributed. Each nurse (p>0.5) their job. 1 www.5 MHz probe for significant difference was found between the transthoracic exams.1) their opinions of their job and working conditions.05) The ECG Holter monitoring continued as long as (Table-II).6) Staff The mean age of nurse was 29.1) and burnout and anxiety. Waukesha. USA) with a 3. 86. Each nurse was examined in burnout scores of nurses with and without AESs terms of heart structure using ECHO.4% had work experience of 1 Shift workers to 10 years.4% stated that they were willingly 4-6 patients 12 (23. All analyses were carried out using the SPSS professional life and work condition.3% of the critical care Competent 40 (78.05) (Table-II).6) of participants were evaluated.05). week. Descriptive data were presented as numbers Socio-demographic characteristics N (%) and percentages.4) RESULTS 11-20 years 11 (21.31±3.Yildiz Denat et al. No statistically Partially satisfied 36 (70.10. The statistical analysis did not reveal any was fitted with a Holter ECG monitor on the significant difference between the mean anxiety morning of a workday before they started work.4) nurses participating in the study.5) of the nurses were female and 76. ECHO findings of all Yes 40 (78. 32 No.0) Do you work with your own willingly 19. Work experience 1-10 years 40 (78. approved by the the Ethics Committee of the Aydin Table-I: Caracteristics of nurses related to Adnan Menderes University Clinical Research. and mean in intensive care unit? anxiety score was 12. The statistical significance Surgical intensive care unit 28 (54.pjms.5) working in the intensive care unit.6% were partially satisfied with their No 32 (62.84.6) 198 Pak J Med Sci 2016 .0.4) participants were normal.5% of them held a No 13 (25. Normally distributed data were Gender analyzed using the Kolmogorov Smirnov test.5% were responsible for the care of Working hours per week 2 or 3 patients during working hours. Holter ECG monitorings No 11(21. and 76.9) 48 hours 22 (43. mean PA score was No 26 (51. 78. Spearman’s correlation analysis was used to Workplaces determine correlations between the cardiac findings Medical intensive care unit 23 (45.5) bachelor’s degree.6% and AESs in 35. the Yes 25 (49. they worked in the intensive care unit and during In the assessment of the relationship between the the night of that workday and was completed cardiac findings and burnout and anxiety scores of in 24 hours. positive correlation was found between Holter ECG only one time and BAI and MBI was the PA sub dimension of burnout scores and applied same day with Holter ECG. the Mann- Male 7 (13.12.001) (Table-III). When asked 40 hours 29 (56.3% Yes 38 (74.37±11.

14 VESs were detected in 21. there were low mean scores of EE however.69 Not detected 14.00.3% of the EE.78 U=274.00.001 -0.067 0. working hours. anxiety scores were low since the study sample was Many studies on burnout in critical care nurses young. p=0. and depersonalization and moderate scores of PA In this study.001 0.50.90±6.09±13.001 0.13. 1 www. p=0.8 ±4. Anxiety & burnout in critical care nurses Table-II: Distribution of burnout and anxiety score means in terms of the presence atrial and ventricular 0.00 18.25 No relationship was found between levels of It has been emphasized that nurses are at high risk anxiety and burnout and prevalence of AESs and of developing anxiety.01 is significant.769 Atrial extrasystole -0. No were found to be similar to those in the present significant difference was found between the mean study.75±7.00 U†/p* U=283.13.14-17 and would not consider changing their job.09 5. p=0. 32 No. p=0. personal life and financial difficulties.16±11.75 13.49 15.68 11.pjms.47 Atrial extrasystole Detected 14. result signified that people feeling a more personal Table-III: Relationship between the cardiac findings and burnout and anxiety scores of nurses.4-6 In a study conducted by Ebrinc units. This suitable for themselves.55 Not detected 14.50. *p<0. A positive correlation was found between et al.14.00 p=0. worries about the future.989 0.28 6.03±11.49 U=266.06 11.4 the anxiety level of critical care nurses was the PA scores of the nurses participating in the found to be higher than that of nurses working study and the number of VESs and AESs.997 ††r: Spearman’s correlarion analysis. as are all other healthcare VESs among nurses working in intensive care professionals. DP and PA scores of critical care nurses the critical care nurses participating in the study.23 20. conducted in intensive care units by Ozden et al. In the in some other 199 . Mann-Whitney U Test.693 0.048 0.100 0.91 18. most Previous studies conducted in Turkey have were willingly working in intensive care and most revealed that critical care nurses experience a believed that they were competent in patient care higher level of burnout than nurses who work in and were partially satisfied with their work-life. p=0. Pak J Med Sci 2016 Vol. finding the job PA scores and the number of VESs and AESs. In the analysis of relationships the profession. Cardiac Finding Burnout Scale Scores Anxiety Score Emotional Exhaustion Personal Accomplishment Depersonalization r†† p r p** r p r p Ventricular extrasystole 0.14 U=195. DISCUSSION feeling unhealthy.61±7.96±7.62±10. more level or high level of burnout and have found that than half had willingly selected the profession half of them show the symptoms of burnout.368 0. DP these features and the study was conducted in the and PA scores of nurses were found to be higher intensive care unit of only one hospital constitutes than those in the present study. including total years in without VESs/AESs. both emotional exhaustion and among nurses working in intensive care units. In the present study.83±6.38 U†/p* U=156. ** p<0.888 0.784 0.59 U=189.219 0. Studies have emphasized that many factors of burnout and anxiety scores of nurses with and may influence burnout.57±3. present study.56 U=197. the EE.54 †U.07±6.61 19.00±4.60±5.83±4.6% and AESs in 35. other departments.00.24 In a study conducted in The fact that the sample group of the study had intensive care units by Dizer et al.50.66 5. while in the study the study limitation.05 is significant. work experience ranged from1 year to10 have revealed that nurses experience a moderate years.12±3. the unit between cardiac findings and burnout and anxiety where the nurse works.3.700 0. p=0. mean anxiety scores were low. a positive correlation was found between with superiors and other teammates. Cardiac Finding Burnout Scale Scores Anxiety Score Emotional Exhaustion Personal Accomplishment Depersonalization Mean±SD Mean±SD Mean±SD Mean±SD Ventricular extrasystole Detected 16.25 4.23.64 U=262. shift work. p=0.00. being happy in relationships scores. most were working 40 hours a week.

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