Expert answer:Article Critique
Expert answer:To prepareReview the Article Critique Assignment Guide in the Walden Library, listed in this week’s Learning Resources.Search the Walden Library for a quantitative article that applies moderation testing.( the article is attached)The AssignmentWrite a 2- to 3-page critique of the research you found in the Walden Library that includes responses to the following prompts:Why did the authors use moderation in their multiple regression model?Do you think moderation is the most appropriate choice? Why or why not?Did the authors display the results in a figure or table?Does the results table stand alone? In other words, are you able to interpret the study from it? Why or why not?USE THE TEMPLATE AND ARTICLE ATTACHED
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Australasian Journal of Organisational Psychology, Volume 8, e1, 1–13
C Australasian Psychological Society Ltd 2015. doi 10.1017/orp.2014.7
Burnout and Engagement in Health Profession
Students: The Relationships Between Study
Demands, Study Resources and Personal
Resources
Tamara G. Robins, Rachel M. Roberts, and Aspa Sarris
The University of Adelaide, Adelaide, South Australia, Australia
Burnout has been related to increased suicidal thoughts, lower self-esteem and dropout in university students.
Engagement in students, however, has been underexplored. This study uses the Job Demands-Resources (JDR) model and the Conservational of Resources (COR) model to contribute to the knowledge about burnout
and engagement in health profession university students. In particular, the role of personal resources, including
psychological flexibility, was examined. Participants were 260 nursing, social work, occupational therapy and
psychology students from 10 Australian universities. Regression analyses were used to test the JD-R model
with a health profession student sample. The model was extended by including personal resources and testing
mediation and moderation hypotheses. Personal resources contributed significant additional variance to the
model. Mediation effects of study demands and resources with psychological flexibility were found, while
moderation effects were not. The results indicate the validity of the JD-R model in a health profession student
population and the important role of personal resources. Further design and evaluation of interventions
targeting personal resources and study demands and resources are indicated.
Keywords: burnout, engagement, personal resources, psychological flexibility, Job Demands-Resources Model
Research is increasingly demonstrating that health profession university students experience high levels of burnout
from their study (DiGiacomo & Adamson, 2001; Jacobs
& Dodd, 2003). Students in the health profession degrees of nursing, social work, psychology and occupational therapy participate in work placements as part of
their study and are therefore exposed to similar stressors
as professionals, as well as academic pressure, deadlines,
and often financial struggles (D. Edwards, Burnard, Bennett, & Hebden, 2010; Rella, Winwood, & Lushington,
2009). Burnout in students has been linked to increased
suicidal ideation, decreased self-esteem and performance,
and dropout (Dyrbye et al., 2008; D. Edwards et al.,
2010; Moneta, 2011). While burnout has been demonstrated to be a problem in university students there has
been little research on study engagement in students. Engagement is the positive antipode to burnout; while work
and study can be stressful and depleting, they can also
be rewarding and energising, and engagement in work is
related to positive health outcomes (Christian & Slaughter, 2007). Preliminary research has linked engagement
to student performance, at times more strongly than
burnout, highlighting the importance of exploring engagement in students (Salanova, Schaufeli, Martinez, &
Breso, 2010). This study aimed to explore burnout and
engagement in health profession students, using relevant
theories and focusing on the role of personal resources.
Research on student burnout and engagement has
rarely used the two most prominent burnout theories,
the Job Demands and Resources (JD-R) and Conservation of Resources (COR) models. This study aimed to
add to the existing burnout and engagement literature by
exploring these concepts in a sample of health profession
students, also including personal resources such as psychological flexibility, which has not been explored in the
context of the JD-R model previously.
ADDRESS FOR CORRESPONDENCE: Ms Tamara G. Robins, c/–
School of Psychology, The University of Adelaide, North
Terrace, Adelaide SA 5005, Australia. Email: tamara.robins@
adelaide.edu.au
1
Tamara G. Robins, Rachel M. Roberts and Aspa Sarris
Current Definitions and Theory
Burnout is most frequently defined as ‘a psychological
syndrome that involves a prolonged response to stressors
in the workplace’ (Maslach, 2003, p. 189), which involves
three dimensions. These consist of exhaustion, which is
considered the starting point from which the two further
components, cynicism (or depersonalisation) and diminished professional efficacy, develop (Maslach, 2003). Exhaustion can be described as a state of ongoing, intense
fatigue in response to demanding work conditions, and
is often considered the key element in burnout (Bakker,
Van Emmerik, & Van Riet, 2008; Maslach, Schaufeli,
& Leiter, 2001). Cynicism is very closely related to the
exhaustion component of burnout and is an act of distancing oneself from work or clients in the attempt to
make work more manageable (Maslach et al., 2001). Professional efficacy relates to feelings of accomplishment
and effectiveness at work. It has been considered less
central to the burnout concept than exhaustion or cynicism (Bakker et al., 2008; Lee & Ashforth, 1996), and
some studies have found it is more related to engagement than burnout (e.g., Schaufeli & Salanova, 2007).
Engagement is a positive and fulfilling state of wellbeing
related to work and study. Schaufeli, Salanova, GonzálezRomá, and Bakker (2002) identified three aspects of engagement: vigour, characterised by high levels of energy
and persistence; dedication, the feeling of being strongly
involved and a sense of pride in one’s work; and absorption, where one is fully absorbed in work and time
passes quickly. Both engagement and burnout have been
explored with student populations. Dyrbye et al. (2011)
found that at graduation 49% of medical students experienced symptoms of burnout. Casuso-Holgado et al.
(2013) found a small but significant correlation between
study engagement and GPA in health science students.
The development of the COR model (Hobfoll,
1989, 2001) and the JD-R model (Demerouti, Bakker,
Nachreiner, & Schaufeli, 2001) has greatly increased
theory-based research in the areas of burnout and engagement. While these models have been used increasingly with employees, there is very little research using
these models with students (see Alarcon, Edwards, &
Menke, 2011; and Salanova et al., 2010, for exceptions).
Research on student burnout and engagement needs to
use relevant theories, such as the JD-R and COR models,
to develop a stronger evidence base around the causes and
consequences of burnout and engagement.
The JD-R model focuses on two processes: the health
impairment process predicts that burnout will occur
when the conditions of high job demands and limited job
resources are met, while the motivational process predicts
that engagement will occur under conditions of high job
resources (Bakker, Demerouti, & Euwema, 2005). Job
demands are aspects of work that require effort, while job
resources are aspects of the job that aid achievement of
work goals, reduce job demands and/or promote personal
2
Australasian Journal of Organisational Psychology
growth and development (Demerouti et al., 2001). There
is a large evidence base supporting this model in workers; Llorens, Bakker, Schaufeli, and Salanova (2006)
demonstrated that demands predicted burnout and resources predicted engagement in many different work
contexts. Demands and resources have been explored
in student burnout and engagement: Dahlin, Fjell, and
Runeson (2010) found that that demands of competence
were related to exhaustion in medical students. Llorens,
Schaufeli, Bakker, and Salanova (2007) found that study
resources led to increased engagement, via increased selfefficacy. However, the JD-R model has not been tested
explicitly in study burnout and engagement.
The COR model and the JD-R model are complementary; the JD-R model provides a robust framework
for burnout and engagement and the COR provides additional information, including recognising the importance
of personal resources (Akhtar & Lee, 2010). The COR
model proposes that stress will occur when there is a threat
to resources, actual loss of resources, or failure to make
adequate gains after investing resources (Hobfoll, 1989).
The COR also outlines resource loss and gain spirals,
where the loss of one resource is likely to lead to further
losses, and having resources leads to further accumulation
of resources (Salanova, Llorens, & Schaufeli, 2011).
The Current Study
This study examined study burnout and engagement in
nursing, occupational therapy, social work and psychology students. While burnout and engagement have been
explored in health profession students, this has largely
occurred in specific disciplines. Comparing across disciplines may provide valuable information about whether
some degrees lead to more burnout or engagement than
others. Mental health in students was also measured, both
to explore the relationship of burnout and engagement
with mental health in students and to review the current mental wellbeing of health profession students. This
study aimed to validate the JD-R model, with the student
population contributing to the theoretical understanding
of burnout and engagement in students as being similar
or different to workers. This study also aimed to extend
on the JD-R framework by incorporating theory from the
COR model. This was achieved by including personal resources in some analyses and by using moderation and
mediation to explore the indirect relationships between
demands and resources and their impact on burnout
and engagement. The study aimed to inform future interventions for burnout and engagement, and variables
were chosen where possible that could be targeted in an
intervention.
The first aim of this study was to use the framework of the JD-R model to explore student burnout and
engagement in a sample of health profession students.
While there has been increasing interest in study burnout
and engagement, very little of this research has used
Burnout and Engagement in Health Profession Students
validated theoretical models. The study demands explored were subjective measures of workload and the
psychological demand of pressure to be a competent professional. Workload, perceived and actual, has been one
of the most frequently measured demands associated with
workplace burnout (e.g., Demerouti et al., 2001). In a
sample of university students, Jacobs and Dodd (2003)
found that while subjective workload predicted high levels of burnout, actual workload was not predictive of
burnout. Another demand strongly related to the health
profession students is the pressure to perform as a competent professional. Worry about future performance and
capability has been linked to exhaustion in medical students (Dahlin et al., 2010). Cherniss’s (1992) qualitative
and longitudinal study of burnout in early career professionals found that burnout in the early years of helping
professionals was often related to demands of competence. As these findings suggest a strong role of pressure
and worry about performance on burnout, the second
demand explored in this study was the pressure to be a
competent professional.
Social support as a work resource has been found
to be very important in both preventing burnout and
increasing engagement (Christian & Slaughter, 2007;
Halbesleben & Buckley, 2004). The COR model suggests that the impact of demands can be reduced by increasing resources that will directly impact that demand
(Halbesleben & Buckley, 2004). Supervisor support may
be particularly important as it can directly target demands such as professional competence and subjective
experience of workload. There are many avenues in which
supervisor support may reduce perceptions of demands,
including aiding students to positively reframe stressful
situations or providing an experienced perspective.
The JD-R model suggests that burnout and engagement can be predicted by a combination of demands and
resources. It suggests that demands will be positively related to burnout and negatively related to engagement,
with the opposite relationship for resources; also, that
demands are more strongly related to burnout than resources, with the opposite relationship for engagement
(Bakker et al., 2005). To test whether the JD-R model fit
with health profession students, the following hypotheses
were formulated:
Hypothesis 1a. It is expected that study demands will
be positively related to burnout and negatively related to engagement.
Hypothesis 1b. It is expected that study resources will
be negatively related to engagement and positively
related to burnout.
The next aim of this study was to expand upon the JDR model, using the COR model, to explore the role
of personal resources in students’ burnout and engagement. While the majority of research exploring work and
study burnout and engagement has been on organisational factors, there have been ongoing recommendations
to explore the role of personal resources (Xanthopoulou,
Bakker, Demerouti, & Schaufeli, 2007, 2009). Personal
resources are important as not all stressors are avoidable and therefore differences in appraisal and varying
ability to cope with stressors may significantly impact
burnout and engagement (Bond, Flaxman, van Veldhoven, & Biron, 2010). Four personal resources were explored, based on relevance, prior research and whether the
variables could be targeted in psychosocial interventions
for burnout and engagement. The personal resources explored were coping, optimism, mindfulness and psychological flexibility.
Coping can be conceptualised as a personal resource
and has been linked to burnout in workers (Riolli &
Savicki, 2003). This study focused on positive reframing
coping. Use of positive reframing coping may lead to perception of demands as less stressful and therefore leads
to reduced burnout, given the importance of perceived
workload versus actual workload in student burnout (Jacobs & Dodd, 2003). Positive reframing is an important
part of cognitive behaviour therapy (CBT) interventions
and it could easily be incorporated into many styles of
intervention.
Optimism is an important concept in the emerging
field of positive psychology, which finds that people who
generally see situations in a more positive or hopeful light
utilise more effective coping strategies than those who see
things more negatively (Scheier & Carver, 1993). Evidence for the role of optimism in workers has been
found, with Riolli and Savicki (2003) demonstrating
that optimism moderated the effects of work resources
on burnout, particularly where work resources were low.
Optimism during university was found to lead to increased work engagement and decreased burnout several
years later (Salmela-Aro, Tolvanen, & Nurmi, 2009).
There are promising interventions for burnout using
mindfulness and acceptance and commitment therapy
(ACT)–based therapies (i.e., Brooker et al., 2013; Flaxman & Bond, 2010). However, there has been very little
research looking at the role of mindfulness or psychological flexibility (an ACT-related concept) as personal
resources impacting burnout or engagement, and none
that the authors are aware of in students. Glomb, Duffy,
Bono, and Yang’s (2011) review of mindfulness in the
workplace describes mindfulness as paying attention to
the present moment, without judgment or evaluation.
Mindfulness may decrease burnout by decreasing rumination, increasing response flexibility and engagement,
and improving affective regulation, as it leads to increased
persistence (Glomb et al., 2011).
Psychological flexibility is a concept from relational
frame theory, a recent empirically validated model, which
proposes that psychological difficulties are developed
through our use of language and the role of avoidance
Australasian Journal of Organisational Psychology
3
Tamara G. Robins, Rachel M. Roberts and Aspa Sarris
in coping (Bond, Hayes, & Barnes-Holmes, 2006). Psychological flexibility is the ability to contact and accept
the present moment, similar to mindfulness, and to use
that acceptance of reality to act in a way that fits one’s values and goals. Bond and Bunce (2003) hypothesised that
psychological flexibility would impact work performance
through a dual action model: first, an employee high in
flexibility would be able to accept their current emotions
and therefore not spend their resources attempting to
solve their emotions; and second, behaviour driven by values leads to an increased ability to focus available resources
on work. Psychological flexibility has been demonstrated
as the active ingredient in reducing burnout in an intervention (Lloyd, Bond, & Flaxman, 2013) but has not
been explored as a personal resource within the COR or
JD-R models in students.
The COR model and previous research suggests that
personal resources are important in explaining burnout
and engagement. To test this, the following hypotheses
were formed:
Hypothesis 2a and 2b: Personal resources, including
psychological flexibility, mindfulness, coping and
optimism, will be (a) negatively related to burnout
and (b) positively related to engagement.
Testing mediation and moderation relationships suggested by the JD-R and COR models has been a recent
focus of burnout and engagement research (Alarcon et al.,
2011). The JD-R model specifies that job resources are
likely to have a moderation relationship with burnout by
buffering job demands (Xanthopoulou, Bakker, Dollard
et al., 2007); for example, if social support is high, the
relationship between work load and exhaustion might
become weaker. It follows that personal resources may
also have a moderating role on job demands. For example, people high in psychological flexibility will likely be
buffered from the effects of study demands on burnout
as they may be able to respond more effectively to demands and find them less draining than people low in
psychological flexibility, preventing a resource loss spiral
where one resource loss leads to another (e.g., Onwezen,
van Veldhoven, & Biron, 2012). The COR model suggests that personal resources may moderate by boosting
the impact of job resources on engagement as part of a
positive gain spiral. For example, Bond and Bunce (2003)
found higher levels of psychological flexibility predicted
a stronger relationship between job control and mental health and work performance, indicating a boosting
effect.
The COR model also suggests that having resources
leads directly to further accumulation of resources; this
may occur by way of mediating relationships between
personal and study resources (Xanthopoulou, Bakker, Demerouti et al., 2007). For example, psychological flexibility could lead to increases in study resources due to
4
Australasian Journal of Organisational Psychology
the value-driven behaviour of those high in psychological
flexibility. Where resources are valued highly, more investment towards procuring and maintaining study resources
will likely occur. People high in psychological flexibility
may be more driven to access supervision or other social
support due to a strong goal focus, which may result in
increased engagement. It was also hypothesised that job
demands could mediate between personal resources and
exhaustion. Personal resources such as psychological flexibility, optimism and mindfulness are all likely to lead to
reduced perception of job demands, which in turn leads to
reduced exhaustion. Xanthopoulou, Bakker, Demerouti
et al. (2007) explored whether job demands could mediate between personal resources (using a measure combining optimism, organisational-based self-esteem and
self-efficacy) and exhaustion, and did not find a significant result. This mediation relationship will be retested
using psychological flexibility in the current study.
An a priori decision was made to test mediation and
moderation effects using only one personal resource, psychological flexibility. There were several reasons behind
this. The first was that although related, the personal resources in …
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