INTRODUCTION

One consequence of work-related stress is burnout syndrome. Although there is no unanimously accepted¹,² definition for this condition, there appears to be agreement in understanding burnout as a psychological phenomenon that arises as a response to chronic and interpersonal work-based stressors³. It is a syndrome characterized by three basic dimensions: emotional exhaustion; depersonalization or cynicism; and a lack of personal fulfilment⁴. Exhaustion describes a progressive loss of energy as tasks are carried out. It is the primary manifestation of burnout and the most commonly declared dimension of it. Depersonalization manifests itself in the form of irritability, negative attitudes and insensitive responses to people. The third dimension of burnout, a lack of personal fulfilment, is characterized by negative responses towards oneself and towards activities undertaken. Individuals express a lack of productivity at work and shortcomings with regard to professional tasks⁵.

The interest that the term burnout is currently attracting⁶ has laid the ground for the extension of this syndrome to pre-occupational samples such as university students, with research into academic burnout⁷,⁸ indicating that students also exhibit fatigue in relation to the tasks that they carry out.

One relevant development in research on burnout has been the study of an opposing construct called engagement³,⁹. Engagement coincides with the positive psychology movement, which attempts to capitalize on favourable aspects of human life to build positive qualities and avoid individuals' dominant concern with negative aspects¹⁰.

Engagement is defined⁹ as a positive state of mind characterized by energy, involvement and efficacy. More specifically, engagement is understood as a positive motivational construct related to work that is characterized by the attributes of strength, dedication and absorption¹¹. It is a cognitive-affective state rather than a specific and temporary state. It persists in time and is not focused on a specific behaviour or object⁹,¹². Vigour refers to high levels of energy in relation to tasks undertaken, as well as to a strong desire to try and persist when obstacles in the road emerge. The characteristic of dedication responds to high levels of meaning in terms of work, as well as to enthusiasm, inspiration, pride and the challenge found in tasks performed. The factor of absorption involves high levels of concentration and happiness while an activity is being performed. The individual is immersed in what he or she is doing and experiences the feeling of time passing very quickly.

While burnout and engagement are talked about as opposing constructs, some research³,⁹,¹³ clarifies that the vigour and dedication of engagement are opposing dimensions to the exhaustion and cynicism of burnout, these latter dimensions being considered the "core of burnout¹⁴".

Recent studies on these constructs display a growing interest in burnout¹⁵⁾ and engagement in the academic field and in samples of university students^{16 17 18}-¹⁹. Following confirmatory analysis of the validity and internal consistency of the instruments that assess these variables¹², whether engagement adds explanatory value to the prediction of indicators of well-being⁹,²⁰ has also been studied. In addition, both constructs have been related to other variables-for example, emotional intelligence²¹,²² and satisfaction²³. Along this same line, the influence of these constructs together with efficacy and academic performance²⁴,²⁵ has recently been analysed, expanding perspectives on burnout and understanding it as a crisis of efficacy, or efficacy as an impetus for engagement¹⁴,²⁶,²⁷.

In the public universities of Castile and Leon (Spain), the educational context of this research, university students, and particularly those in nursing, must overcome the academic challenges set in the curricula that occupy most of their time. Students are involved in theoretical tasks organized under a strict schedule and must also participate in clinical practice, where productive behaviours and activities-all of which are forms of knowledge-are required of them and subject to evaluation. Public higher education institutions must pay attention to the emotional state of students in situations of learning²⁷, since the ability to deal with stressful situations during their education will depend on their personal disposition in dealing with academic demands²⁸.

The objectives of the this study are to describe the level of burnout and engagement in nursing students at public universities in the Castile and Leon region of Spain; to analyse the relationship, association and prediction arising from the dimensions of emotional exhaustion, cynicism and academic efficacy of burnout and levels of absorption, dedication and vigour from engagement; and to analyse differences in means, comparing groups of men and women. We present these objectives in order to understand more about these variables and their relationship, with the goal of identifying possible intervention needs that may ensure teaching quality and provide university students with resources for their academic and professional futures and skills for success in a public university institution.

MATERIAL AND METHOD

Research design

This is a piece of quantitative research that does not involve an intervention. It is a cross-sectional descriptive study. We analyse differences between groups of men and women as well as the correlations and predictions that are established between the different study variables, burnout and engagement.

Subjects and scope of study

The study population was degree-level nursing students enrolled in the 2009/2010 academic year. The students belonged to Castile and Leon's four public universities: the University of Burgos, the University of Leon, the University of Salamanca and the University of Valladolid.

Data collection instruments

-Maslasch Burnout Inventory-Students Survey (MBI-SS), adapted to measure the level of burnout in university students ¹² and validated for the Spanish population²⁸. This scale contains 15 items that assess the dimensions of exhaustion (= .876), cynicism (=0.826) and academic efficacy (=0.663); all these aspects are linked to feelings, beliefs and behaviours related to the experience as a "student" at the university level. The response range of the various items is from 0 to 6 on a Likert-type scale. In the scale, 0 indicates total disagreement and 6 total agreement. The student was most burned out when he or she exhibited high scores in exhaustion and cynicism and low scores in his or her belief in academic efficacy.

-Utrecht Work engagement Student (UWES-S) Survey, adapted to measure the level of engagement in university students¹² and validated for the Spanish population²⁹,³⁰. We used this 17-item scale to measure the three dimensions of this construct in students: vigour (=0.792), dedication (=0.791) and absorption (=0.802). Survey respondents' answers are quantified according to a Likert-type scale, in which 0 indicates total disagreement and 6 total agreement with the statement contained in the item. High scores in these dimensions reflect high levels of academic engagement.

The socio-demographic characteristics were: sex, age, and university where studies were being undertaken.

Procedure

Written permission was requested from the participating universities to administer the surveys. After a favourable response was received, arrangements were made with the four public universities as to the most appropriate day and time to visit the corresponding university and proceed with data collection. In the classroom environment, and prior to administering the surveys, the principal investigator provided information orally and in writing, through the information and informed consent forms (which did not need to be signed so as to preserve anonymity), on the objectives of the study, and they also answered relevant questions asked by students. After assuring all participating individuals of their anonymity and the voluntary nature of participation in the study, the surveys were handed out so that they could be completed individually. It took students approximately 20 minutes to fill in the surveys.

Data analysis

The data analysis techniques used were descriptive statistics (central trend and dispersion trend), linear correlation analysis (Pearson correlation coefficient), t-test analysis with Student's t test and multiple linear regression analysis, to develop predictions on a variable based on others. In order to establish the psychometric indicators of the measurement instruments, the Cronbach's alpha reliability coefficient () was analysed.

The aforementioned statistical analyses and database were produced using SPSS 21.0 (Statistical Package for the Social Sciences).

Ethical Considerations

The study protocol and instruments were approved by the Executive Commission of the Ethics Committee of the University of Leon.

The proposed research respected the fundamental principles of the Helsinki Declaration, as well as the ethical principles of the nursing profession established in relation to research by the Spanish Nursing Code of Ethics.

The surveys were accompanied by an information sheet and verbal and written consent.

RESULTS

A total of 1,009 nursing students enrolled in the four public universities of Castile and Leon participated on a voluntary and anonymous basis. The mean age was 21.53 years. The characteristics of the subjects and the distribution of participants by universities are shown in Table 1 ²⁰. The predominant sex was female, with 859 women (85.1%) and 127 men (12.7%). Students who responded incorrectly to or did not complete the variable sex were considered under the category of unknown. There were 23 participants of unknown sex in the sample (2.3%).

Table 1 socio-demographic characteristics of nursing students at public universities in Castile and Leon (Spain). 

Means, standard deviations, Pearson correlations and reliability coefficients of measurement instruments are shown in Table 2. As can be seen, Cronbach's alpha exceeds or approaches the preferable criterion of 0.70³¹⁾ in the dimensions analysed.

Table 2 Descriptive statistics and reliability coefficients of the measurement instruments for burnout and engagement among nursing students at public universities in Castile and Leon. 

^* Correlation is significant at the 0.01 (bilateral) level.

** Correlation is significant at the 0.05 (bilateral) level.

As Table 2 shows, the results explain how the dimensions of burnout correlate with one another. In addition, the association between exhaustion and cynicism is stronger than that found for academic efficacy. Academic efficacy presents a moderate positive correlation with the variables of engagement; the results demonstrate that the greater the academic efficacy displayed by the students, the lower the scores obtained for exhaustion and cynicism and the higher engagement (absorption, dedication and vigour) is. The three dimensions of engagement positively and significantly correlated with one another.

To find out if the variables behaved differently depending on the sex of individuals, the t test was used for independent samples (see Table 3). Statistically significant differences were found in the comparison of means between women and men for scores in cynicism, academic efficacy, absorption and dedication. Women scored significantly higher in these variables than did men, except in the case of cynicism, where they scored lower.

Table 3 Descriptive statistics and t test according to the sex of nursing students at public universities in Castile and Leon. 

Following on from the evidence of correlations between academic efficacy and the rest of the variables studied, multiple linear regression analysis shows that Model 2 explains 31.1% of the variance of academic efficacy, as shown in Table 4. For this analysis, the stepwise model was followed (criterion: Prob. of F entering < = 0.050, Prob. of F exiting > = 0.100). The variables vigour (beta = 0. 417, t =-13.335 and p < 0.001) and dedication (beta = 0.212, t = 6.776 and p < 0.001) are those which explain most variability. An increase in the scores for vigour and dedication (engagement) perceived by students predicts higher scores in academic efficacy.

Table 4 Linear regression for the dependent variable academic efficacy, nursing students at public universities in Castile and Leon. 

* p=0.000

DISCUSSION

The results obtained show that all the dimensions of engagement strongly and positively correlate with one another in the case of nursing students in Castile and Leon. Dedication is the variable of engagement in which the highest values were obtained. This finding has been confirmed by other studies¹⁶,²³, where relationships between this variable and satisfaction, time management or welfare²⁰ were also found among students. In the case of burnout, the association is positive and moderate for exhaustion and cynicism, and negative and weaker in the case of academic efficacy and the other two factors of the construct. These data strengthen the consistent nature of the two core dimensions of burnout and the tendency to analyse it as a crisis of self-efficacy¹⁸, such that the greater the academic efficacy shown by nursing students at the public universities of Castile and Leon, the lower the levels of exhaustion and cynicism. As was expected, others results obtained along this line that have found associations that are very close to those found in the present study⁹,¹⁴,¹⁷,¹⁹,²¹,²⁶,²⁷ have been confirmed.

In addition, research that seeks to identify differences based on the sex of the subjects shows that there is no unanimity, and thus some studies²¹ have not found statistically significant differences in any of the three dimensions of burnout, though they did find significantly higher values for dedication for women. However, in other research¹⁷, no differences in means according to the sex for these variables studied were found. In the study population presented, as in the study carried out by other authors¹ significant differences were found according to sex for cynicism, efficacy, absorption and dedication. Women adopt fewer distant and negative attitudes; they are less cynical; and they appraise greater efficacy in themselves. They also presented higher levels of absorption, enthusiasm, inspiration, pride and challenge (dedication) than did men.

With regard to the relationship between burnout and engagement, the results support other empirical research⁹,¹²,¹⁴,¹⁷,²⁶. For example, the conclusions of research focused on tourism students¹³ suggest that the unfavourable nature of burnout (high levels of exhaustion and cynicism and low efficacy) decreases students' commitment to their academic activity (decreased academic absorption, vigour and dedication). By contrast, the results²⁴ from a sample of first-year medical students indicate that these students are academically focused and committed (high levels of engagement), while in relation to the opposing construct of burnout, the students presented a low degree of exhaustion or emotional tiredness. In the sample studied, we observed that the factor of academic efficacy correlates significantly and positively with engagement and negatively with burnout. That is, students with high personal expectations and positive self-assessment also exhibited fewer feelings of fatigue or exhaustion, a lower adoption of negative attitudes or cynicism, and a greater motivation, characterized by vigour, dedication and absorption, in relation to tasks. Regression analysis shows the influence of the variables of vigour and dedication on academic efficacy, and so the future nursing professionals studied who had high values in vigour and dedication scored highly in academic efficacy.

Limitations

The results obtained do not allow conclusions to be drawn about the causality between the variables studied, and so it would be necessary to develop longitudinal or experimental studies that delve into this issue.

The subjects studied are not representative of the university population as a whole, since they only come from the nursing branch of the health sciences.

There is also a bias in terms of sex, since the set of subjects is not homogeneous for this variable. As a result, the results and conclusions about gender differences must be taken cautiously.

Finally, this study used a self-reporting measure for data collection, in which the results could have been exaggerated.

CONCLUSIONS

Nursing students in Castile and Leon are more burned out when they exhibit high scores in exhaustion and cynicism and low scores in self-efficacy. Furthermore, the results relating to the three dimensions of engagement indicate that they are highly correlated with one another, as a result of which high scores in these scales indicate high levels of academic engagement.

The female university students who participated in the study were revealed to be less cynical and to evaluate their academic efficacy more highly. In addition, they presented higher levels of absorption and dedication than did men.

Students with high academic efficacy had fewer feelings of emotional exhaustion, lower scores in cynicism, and a greater engagement with or commitment to studies, which was characterized by vigour, dedication and absorption.

The relationship between these two constructs highlights the positive influence of engagement on students' academic efficacy. To approach the question from the positivity perspective, it could be said that the results indicate that students who have vigour and are dedicated to their tasks feel greater levels of efficacy with regard to their studies and have lower levels of burnout. As has been described, the fostering of engagement (vigour and dedication) can offer an opportunity for students to handle academic tasks and to properly complete studies (academic efficacy), as well as to face the world of work with a greater probability of success.

In our view, it is necessary for more studies to be carried out in relation to this theme. The next logical step, owing to the incipient phase in which engagement sits at present, would be to study in greater depth the relations with others variables of a personal nature (emotional intelligence, health, affective state, sense of coherence, coping mechanisms and so on) and those linked to the university institution (contextual, organizational and academic variable), and the sample could be extended to other domains. It would also be interesting for universities to establish strategic plans to promote health in university environments and enhance academic engagement (motivation for studying). These skills are especially pertinent for nursing students, since a commitment on their part to their studies could entail better academic outcomes and possibly result in better personal well-being and in quality care in the population.