How does emotional exhaustion influence work stress? Relationships between stressor appraisals, hedonic tone, and fatigue in nurses' daily tasks: A longitudinal cohort study

Int J Nurs Stud. 2017 Oct:75:43-50. doi: 10.1016/j.ijnurstu.2017.07.002. Epub 2017 Jul 5.


Background: Work-related stress is a prevalent condition in the nursing profession, and its influence may vary according to changeable individual and situational factors. It is, therefore, important to investigate the real-time momentary changes in these factors and their relationship to emotional exhaustion experienced by nurses.

Objectives: We aim to analyse how their perceptions of demand, control, effort and reward change according to the task performed through real-time assessment and interact with the emotional exhaustion level of ward nurses.

Design: The research design was longitudinal.

Method: A three-level hierarchical model with a repeated measures design was used to assess the momentary self-reports of 96 hospital ward nurses, completed using a smartphone programmed with random alarms.

Results: Findings show that demand, effort, and control appraisals depend on the task performed. The task appraised as most demanding, effortful, and controllable was direct care. Reward appraisal depends on the task performed and personal variables, i.e. emotional exhaustion. The situations perceived as more rewarding were rest and direct care. Momentary hedonic tone can be explained by the task performed, demand, reward, emotional exhaustion and by the interaction between emotional exhaustion and demand appraisal. Momentary fatigue can be explained by the task performed, demand, reward, and the emotional exhaustion.

Conclusions: This study highlights the importance of using momentary measures to understand complex and changeable inter-relationships. While also clarifying the targets of intervention programmes aimed at preventing burnout within the nursing profession.

Keywords: Burnout; Control; Demand; Ecological momentary assessment; Emotional exhaustion; Ward nurses.

MeSH terms

  • Adult
  • Burnout, Professional*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Nursing Staff / psychology*
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Workplace