Burnout and Human Needs Fulfillment Based on Watson’s Ninth Carative Factor: A Correlational Study Among Hemodialysis Nurses in Malang, Indonesia
DOI:
https://doi.org/10.55018/janh.v7i2.349Keywords:
Burnout, Nurse-Patient Relations, Nurses, Nursing Theory, Renal DialysisAbstract
Background: Burnout among hemodialysis nurses has reached critical levels globally. Grounded in Watson's Theory of Human Caring, this study examined the relationship between Watson's ninth carative factor (assisting with human needs gratification while preserving dignity and wholeness) and burnout levels among hemodialysis nurses.
Methods: A cross-sectional correlational study was conducted among 113 hemodialysis nurses from the Indonesian Dialysis Nurses Association in Malang (April-May 2025). Stratified random sampling used Slovin's formula with 5% margin of error. Inclusion criteria: actively working hemodialysis nurses providing informed consent. Exclusion criteria: nurses on leave, retired, experiencing health issues, or in training programs. Burnout (independent variable) was measured using Professional Quality of Life Scale version V (ProQOL-V) burnout subscale (10 items, 5-point Likert, scores 10-55). Human needs fulfillment (dependent variable) used 10 items from Caring Nurse-Patient Interactions Scale (5-point Likert, scores 10-50). Both instruments underwent pilot testing (n=10), demonstrating validity (r>0.632) and reliability (Cronbach's α>0.6). Data collection utilized online surveys. Statistical analysis employed Spearman's correlation (α=0.05).
.
Results: Participants were predominantly female (59.3%), aged 36-45 years (48.7%), with bachelor's degrees plus nursing credentials (53.1%), and >5 years experience (65.5%). Burnout distribution: 56.6% low, 43.4% moderate, 0% high. Human needs fulfillment: 90.3% high, 9.7% moderate, 0% low. Spearman's analysis revealed significant negative correlation between burnout and human needs fulfillment (ρ=-0.446, p<0.001, moderate effect size).
Conclusion: Higher implementation of Watson's ninth carative factor significantly reduces burnout among hemodialysis nurses. The theoretical model demonstrates that addressing patients' holistic needs while preserving dignity creates meaningful work experiences protecting nurses from burnout. Healthcare organizations should integrate Watson's Theory into professional development programs. Future longitudinal studies across diverse contexts are recommended to establish causal relationships.
Downloads
References
Afonso, S. da R., Padilha, M. I., Neves, V. R., Elizondo, N. R., & Vieira, R. Q. (2024). Critical analysis of the scientific production on Jean Watson’s Theory of Human Care. Revista Brasileira de Enfermagem, 77(2), e20230231. https://doi.org/10.1590/0034-7167-2023-0231
Akbari, A., & Nasiri, A. (2022). A concept analysis of Watson’s nursing Caritas process. 57(6), 1465–1471. https://doi.org/10.1111/nuf.12771
Altaker, K. W., Howie-Esquivel, J., & Cataldo, J. K. (2018). Relationships among palliative care, ethical climate, empowerment, and moral distress in intensive care unit nurses. American Journal of Critical Care, 27(4), 295–302. https://doi.org/10.4037/ajcc2018252
Babapour, A.-R., Gahassab-Mozaffari, N., & Fathnezhad-Kazemi, A. (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: A cross-sectional study. BMC Nursing, 21(1), 75. https://doi.org/10.1186/s12912-022-00852-y
Bakhamis, L., Paul III, D. P., Smith, H., & Coustasse, A. (2019). Still an epidemic: The burnout syndrome in hospital registered nurses. The Health Care Manager, 38(1), 3–10. https://doi.org/10.1097/HCM.0000000000000243
Bidik, G., & Sisman, F. N. (2024). Mindful self-compassion program based on Watson’s theory of human caring in nursing students: A randomized controlled study. Archives of Psychiatric Nursing, 51, 30–37. https://doi.org/10.1016/j.apnu.2024.04.003
Cossette, S., Cara, C., Ricard, N., & Pepin, J. (2005). Assessing nurse–patient interactions from a caring perspective: Report of the development and preliminary psychometric testing of the Caring Nurse–Patient Interactions Scale. International Journal of Nursing Studies, 42(6), 673–686. https://doi.org/10.1016/j.ijnurstu.2004.10.004
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18, 1–17. https://doi.org/10.1186/s12960-020-00469-9
Delgado-Galeano, M., Ibáñez-Alfonso, L. E., Villamizar-Carvajal, B., & Durán de Villalobos, M. M. (2023). Transpersonal Caritas Relationship: A new concept from the unitary caring science framework of Jean Watson. Investigación y Educación En Enfermería, 41(3). https://doi.org/10.17533/udea.iee.v41n3e02
Galanis, P., Moisoglou, I., Katsiroumpa, A., Vraka, I., Siskou, O., Konstantakopoulou, O., Meimeti, E., & Kaitelidou, D. (2023). Increased job burnout and reduced job satisfaction for nurses compared to other healthcare workers after the COVID-19 pandemic. Nursing Reports, 13(3), 1090–1100. https://doi.org/10.3390/nursrep13030095
Galanis, P., Moisoglou, I., Papathanasiou, I. V., Malliarou, M., Katsiroumpa, A., Vraka, I., Siskou, O., Konstantakopoulou, O., & Kaitelidou, D. (2024). Association between organizational support and turnover intention in nurses: A systematic review and meta-analysis. 12(3), 291. https://doi.org/10.3390/healthcare12030291
Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID‐19 pandemic: A systematic review and meta‐analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839
Ge, M., Hu, F., Jia, Y., Tang, W., Zhang, W., & Chen, H. (2023). Global prevalence of nursing burnout syndrome and temporal trends for the last 10 years: A meta‐analysis of 94 studies covering over 30 countries. Journal of Clinical Nursing, 32(17–18), 5836–5854. https://doi.org/10.1111/jocn.16708
Gunawan, J., Aungsuroch, Y., Watson, J., & Marzilli, C. (2022). Nursing Administration: Watson’s Theory of Human Caring. Nursing Science Quarterly, 35(2), 235–243. https://doi.org/10.1177/08943184211070582
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2018). Nursing shortage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175
Hsu, H.-C., Lee, H.-F., Hung, H.-M., Chen, Y.-L., Yen, M., Chiang, H.-Y., Chow, L.-H., Fetzer, S. J., & Mu, P.-F. (2024). Effectiveness of Individual‐Based Strategies to Reduce Nurse Burnout: An Umbrella Review. Journal of Nursing Management, 2024(1), 8544725. https://doi.org/10.1155/2024/8544725
Jun, J., Ojemeni, M. M., Kalamani, R., Tong, J., & Crecelius, M. L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies, 119, 103933. https://doi.org/10.1016/j.ijnurstu.2021.103933
Khatatbeh, H., Pakai, A., Al‐Dwaikat, T., Onchonga, D., Amer, F., Prémusz, V., & Oláh, A. (2022). Nurses’ burnout and quality of life: A systematic review and critical analysis of measures used. Nursing Open, 9(3), 1564–1574. https://doi.org/10.1002/nop2.936
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.
Ling, K., Xianxiu, W., & Xiaowei, Z. (2020). Analysis of nurses’ job burnout and coping strategies in hemodialysis centers. Medicine, 99(17), e19951. https://doi.org/10.1097/MD.0000000000019951
Molina-Praena, J., Ramirez-Baena, L., Gómez-Urquiza, J. L., Cañadas, G. R., De la Fuente, E. I., & Cañadas-De la Fuente, G. A. (2018). Levels of burnout and risk factors in medical area nurses: A meta-analytic study. International Journal of Environmental Research and Public Health, 15(12), 2800. https://doi.org/10.3390/ijerph15122800
Rutledge, D. N., Douville, S., & Winokur, E. J. (2024). Nurses’ Generational Differences of Burnout and Turnover Risk. Online Journal of Issues in Nursing, 29(3), 1–13. https://doi.org/10.3912/OJIN.Vol29No03PPT30
Schluter, J., Seaton, P., & Chaboyer, W. (2008). Critical incident technique: A user’s guide for nurse researchers. Journal of Advanced Nursing, 61(1), 107–114. https://doi.org/10.1111/j.1365-2648.2007.04490.x
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469–e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469
Stamm, B. H. (2009). Professional quality of life scale (ProQOL): Compassion satisfaction and compassion fatigue (ProQOL) Version 5. www.proqol.org
Sudijono, A. (2001). Pengantar evaluasi pendidikan. Depok: PT. Raja Grafndo Persada.
Watson, J. (2013). Nursing: The philosophy and science of caring, revised edition. Caring in Nursing Classics: An Essential Resource, 243–264.
West, M., Eckert, R., Collins, B., & Chowla, R. (2017). Caring to change. How Compassionate Leadership Can Stimulate Innovation in Health Care. London, UK: The King’s Fund.
Woo, T., Ho, R., Tang, A., & Tam, W. (2020). Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. Journal of Psychiatric Research, 123, 9–20. https://doi.org/10.1016/j.jpsychires.2019.12.015
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ns. Suci Wulandari Sassanti, S.Kep., Prof. Dr. Titin Andri Wihastuti, S.Kp., M.Kes, Dr. Ns. Dina Dewi Sartika Lestari Ismail, S.Kep.,M.Kep.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.














