Burnout and quality of life among nursing professionals in the Ashanti Region of Ghana

¹Akenten Appiah-Menkah University of Skills Training and Entrepreneurial Development, Kumasi, Ghana, ²Department of Public Health, Ada West Municipal Health Directorate, Accra, Ghana, ³Winneba COLANGE Clinic, University of Education, Winneba, Ghana, ⁴Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, ⁵Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands

^&Corresponding author
Oscar Vetsi, Department of Public Health, Ada West Municipal Health Directorate, Accra, Ghana

Introduction    

Burnout has recently gained attention because of its impact on professionals and the quality of service provision in healthcare settings. Globally, up to 58.0% of healthcare workers experience burnout [1]. The World Health Organization (WHO) defines burnout as a syndrome thought to be caused by ongoing workplace stress that has not been effectively controlled. Burnout has three dimensions: emotional exhaustion, depersonalization, and personal accomplishment [2]. This can result in energy exhaustion, neglect of core workplace responsibilities, loss of confidence, and inability to complete tasks. Owing to its public health interest, the WHO has classified it as an occupational disease according to the International Classification of Diseases (ICD-11).

Several studies have shown a high prevalence of burnout among health workers in both high- and low-income countries, with a higher prevalence among nurses and midwives than among other healthcare workers [3-5]. A systematic review and meta-analysis [6] reported a pooled burnout prevalence of 11.23% among nurses worldwide. A study in Singapore found that 39.0%, 40.0%, and 59.0% of nurses working in tertiary hospitals experienced high emotional exhaustion, depersonalization, and low personal accomplishments, respectively [6]. In Ethiopia, a pooled prevalence of burnout has been reported in 39.0% of nurses. In Uganda, research has reported that approximately 40.0% of healthcare workers experience high burnout [7].

Similarly, a study in Malawi reported that approximately 55.0%, 31.0%, and 46.0% of healthcare workers experienced average emotional exhaustion, depersonalization, and reduced personal accomplishments, respectively [8]. According to Nigerian reports, nurses at tertiary hospitals experience high emotional exhaustion (42.9%), depersonalisation (47.6%), and reduced personal accomplishments (53.8%). Another study in Nigeria reported that approximately 69.0% of healthcare workers experienced burnout [9]. Ghana reported that approximately 9.90% of healthcare workers in the Greater Accra Region experienced burnout. In the Ashanti Region of Ghana, Nwosu et al. [10] found that approximately 2.1% of nurses working in tertiary hospitals experienced burnout.

Nursing professionals constitute the majority of the healthcare workforce and are primarily responsible for aiding patients in preventing diseases and improving their health [11]. The success of Sustainable Development Goal (SDG) three (3), which is good health and well-being for all [12], is largely dependent on the quality of services provided by nursing professionals globally. Assessing burnout in nursing professionals is key to the progress of the healthcare sector because burnout negatively affects not only health professionals but also the health and safety of patients [13].

Burnout among nursing professionals is problematic for the nursing workforce, considering its effect on the quality of life (QoL) of professionals and the global shortage of nurses [14]. Quality of life is important for nursing professionals and should not be overlooked. Quality of life is defined as an individual´s overall well-being and encompasses goals, targets, standards, and living conditions. This usually reflects the issues or things that they cherish [15]. It affects a person's psychological, social, and physical capabilities [14]. It has been reported that the hospital environment can significantly influence the QoL of nursing professionals [16]. Nurses' QoL can also be influenced by factors such as age, sex, management support, educational level, and income level [17]. The QoL of nursing professionals can have a direct impact on the quality of service provided, organizational commitment, and job satisfaction [18].

Nursing professionals are heavily involved in providing quality healthcare to patients in the workplace [12]. Hence, they are mostly exposed to several workplace hazards, such as high workload, stress, and violence, which may increase their burnout levels in the workplace [16,19]. Considering its significance in providing quality healthcare, there is a need to protect the nursing workforce. Again, the QoL of nursing professionals may be affected by burnout in the workplace [20]. Several studies have reported that exposure to stressors in the workplace increases nurses' risk of burnout, which can subsequently hurt their quality of life and social health [14,21]. In Ghana, some studies have been conducted to determine the prevalence of burnout among nurses and other healthcare professionals [22] indicated that healthcare workers' unpreparedness toward coronavirus disease 2019 (COVID-19) had an increased risk of burnout Asiedu et al. [23] reported the effect of family-to-work conflict on burnout, and Opoku et al. [11] reported the adverse effect of burnout on the desire to leave the nursing and midwifery professions. However, these studies have failed to consider the effects of burnout on the QoL of nursing professionals. Therefore, this study sought to address this literature gap among nursing professionals in Ghana and provide data that will help inform policy directions, especially among nursing professionals, thereby helping achieve the Sustainable Development Goals. This study aimed to determine burnout and its association with QoL among nursing professionals in the Mampong and Agona Municipalities in the Ashanti region of Ghana.

Methods     

Study design and setting: this institution-based, analytical, cross-sectional study was conducted with 343 nursing professionals to ascertain burnout and its association with QoL. The Mampong Government Hospital (MGH) and Seventh Day Adventist Hospital, Asamang (SDAH), in the Mampong Municipality and Atwima Nwabiagya Districts, respectively, in the Ashanti Region of Ghana, were the study settings. The Mampong Municipality and Atwima Nwabiagya District constitute the forty-three municipal districts in the Ashanti region. These two districts have more than 15 health facilities, including hospitals, maternity homes, health centres, private facilities, and clinics. These health facilities provide a wide range of medical services to the inhabitants.

Mampong Government Hospital is a district-level hospital that provides 24-hour services to communities in the municipality. It provides a wide range of medical services and is a referral centre for other health centres and nearby private facilities. The Seventh-Day Adventist Hospital, Asamang, is located in Asamang, in the Atwima Nwabiagya District of the Ashanti Region. Hospitals are known to provide healthcare to districts. It runs a 24-hour service. This facility also served as a major referral point for other facilities within the district. These facilities were selected because they are among the health facilities in these districts that are mostly visited by healthcare services and are referral facilities.

Study population: a total of 420 registered nurses and midwives working in Mampong Government and Seventh-Day Adventist Hospitals were included in the study. Nursing practitioners are certified or licensed as nurses or midwives and offer patient care.

Inclusion and exclusion criteria: all certified/registered nurses and midwives who had practiced for at least one year were included in the study. Registered nurses and midwives on annual leave during the data collection period were excluded. Nursing professionals who declined to participate or failed to provide consent were also excluded.

Sample size estimation: the Charan and Biswas formula was used to estimate the sample size for the study [24]:

Sampling technique: this study employed simple random sampling techniques to select study participants. The proportional allocation of the study participants was based on the number of nursing professionals in the two facilities. A list of nursing professionals at each facility was retrieved from the deputy director of nursing services. The names of the nurses and midwives were assigned codes, and ballots were entered. An independent participant performed the balloon procedure. The code was written, folded, and placed in an A3 envelope on a piece of paper. The envelope was then shaken to ensure blending. The paper was drawn from the envelope until the estimated sample size for each facility was obtained. The names of nursing professionals corresponding to the codes drawn were contacted and screened for the study before recruitment.

Data collection instrument: data were collected using a pre-tested structured questionnaire. The questionnaire was used to gather data on sociodemographic characteristics (such as age, sex, educational level, and income level), workplace environment (e.g., years of practice, management support, hours of work, shift type, and leadership style), burnout, and QOL.

The Maslach Burnout Inventory (MBI) was used to assess burnout in the study population [26]. The MBI is an internationally validated tool for assessing burnout that has been used in numerous studies [27]. The MBI measures burnout in three dimensions: emotional exhaustion, depersonalisation, and personal accomplishment. A 7-point Likert scale was used to rate each sub-item (0 - 6). Each study participant's overall score for each burnout dimension was calculated. Overall, burnout was defined as high burnout for emotional exhaustion and depersonalisation and low burnout for personal accomplishment [28].

The QoL of the study participants was measured using a questionnaire from the World Health Organization on QoL of the study participants [27,29]. The WHO QoL questionnaire is an approved tool employed in numerous studies to measure the QoL of nurses [30]. This tool has 24 items that assess QoL in four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environment (8 items), using a 5-point Likert scale. The mean scores of the different components in each domain were used to determine the scores for each of the four domains. Each domain score was expressed as a percentage of 0 to 100. The overall QoL score was computed by adding the scores of each domain and was expressed as a percentage. The QoL of study participants increased as their QoL scores increased. The questionnaire was pre-tested with ten nurses from different districts. Corrections were made to the questionnaire after the pre-test, before it was sent to the field for data collection.

Data analysis: data were analyzed using the Stata statistical software version 16. Descriptive computations were performed to determine the general characteristics. Univariate and multivariate linear regression analyses were used to predict the factors associated with burnout dimensions and the effects of burnout dimensions on QOL. Covariates that were independently significant in the univariate analysis (p <0.05), together with non-significant covariates (p <0.2), were included in the multivariate linear regression analysis using a backward stepwise approach. For the effect of burnout dimensions on nurses' QOL, variables such as age, gender, and years of work, together with all burnout dimensions, were fitted in a multivariate linear regression using a backward stepwise approach to the model to predict the effect of burnout dimensions on QOL. All analyses maintained a significance level of p <0.05, at a 95% confidence interval.

The study period: ethical clearance was obtained on 10^th January, 2023, with prior approval from the hospital on 28^th October, 2022. This study commenced in January 2023 and was completed in March 2023.

Ethics approval and consent to participate: the Committee for Human Research, Publication, and Ethics of the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, provided ethical clearance for this research with reference number (CHRPE/AP/013/23). Informed consent was obtained from all participants prior to data collection.

Results     

Demographic characteristics of study participants: the demographic characteristics of the participants are presented in Table 1. Of the 350 nursing professionals recruited, 343 returned the questionnaires, yielding a response rate of 98.0%. Nearly half of the participants (49.9%) were between the ages of 20 and 29 years, with a mean age (S.D) of 29.6 (±5.4) years and a range of 20 to 54 years. Approximately two-thirds (67.1%) of the study participants were female, and approximately half (51.0%) were married. More than two-thirds (63.3%) of the study participants were degree holders. Fifty-three (15.5%) participants indicated that they consumed alcohol, while twenty-four (7.0%) of the study participants indicated that they smoked.

Work-related characteristics of study participants: the work-related characteristics of the participants are presented in Table 2. More than half (53.9%) were working at Mampong Government Hospital, over a third (36.2%) of the study participants were on a monthly salary of less than Gh¢2000.00, and almost all (95.9%) were permanent staff. Eighty-eight (25.7%) study participants were in the Department of Eye/Dental. More than half (54.8%) of the participants were staff nurses and midwives, and nearly half (48.4%) had less than five years of professional experience, with a median working experience of five (IQR: four) years, ranging from one to 40 years. Almost all participants (93.9%) perceived their work to be stressful, nearly two-thirds (62.1%) had a majority of their shifts in the afternoon, and more than half (56.9%) received adequate support from management. Adequate management support includes (1) regular supervision, (2) timely responses to work concerns, (3) availability of necessary resources, and (4) constructive feedback. This was measured using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) for each component, with scores of ≥4 considered adequate support. Overall, 56.9% of participants reported receiving sufficient support.

Prevalence of burnout among study participants: the descriptive statistics of the burnout components are presented in Table 3. The median scores for emotional exhaustion, depersonalisation, and personal accomplishment were 15 (IQR: 27), 25 (IQR: 16), and 32 (IQR: 12), respectively, suggesting low burnout for emotional exhaustion and high burnout for both. Slightly over one-fifth (20.7%) of the participants experienced high emotional exhaustion, whereas the majority (83.6%) and over two-thirds experienced high depersonalisation and personal accomplishment, respectively. The overall burnout rate was 2.9%.

Factors associated with emotional exhaustion: we present both unadjusted (model 1) and adjusted (model 2) regression analyses, where model 2 accounts for all significant covariates (p <0.05) identified during model development. Linear regression analysis revealed that working night shifts (î² = 6.06, p = 0.032) and inadequate support from management (î² = 2.89, p = 0.042) were significant predictors of emotional exhaustion among nurses and midwives. Specifically, nurses and midwives who worked night shifts experienced a 6.06-point increase in emotional exhaustion, whereas those who received inadequate support from management experienced a 2.89-point increase.

These factors accounted for approximately 3.3% of the variation in emotional exhaustion (adjusted R2 = 0.033, p = 0.016), indicating a significant relationship. Furthermore, the results suggest that being married (β = -2.91, p = 0.039) and holding a senior nursing position (β = -5.64, p = 0.031) may have protective effects against emotional exhaustion (Table 4).

Factors associated with depersonalization: Table 5 presents the results of the analysis. This revealed that holding a senior nursing position and working full-day shifts were significant predictors of depersonalisation among nurses and midwives. Specifically, nurses and midwives who held positions as nursing/midwifery officers experienced a 3.57-point increase in depersonalisation (β = 3.57, p = 0.015), whereas those in principal nursing/midwifery officers experienced a 5.00-point increase (β = 5.00, p = 0.076). Additionally, working full-day shifts was associated with a 7.69-point decrease in depersonalization (β = -7.69, p = 0.010), suggesting that this type of shift may have a protective effect against depersonalization.

These factors accounted for approximately 3.6% of the variation in depersonalisation (adjusted R2 = 0.036, p = 0.007), indicating a significant relationship. Furthermore, the results suggested that age, work experience, gender, and relationship status did not significantly predict depersonalisation among nurses and midwives.

Linear regression analysis was performed to identify the significant predictors of all dimensions of burnout. After adjusting for significant variables, emotional exhaustion was predicted by night shifts (adjusted β: 6.06, 95%CI: 1.52, 11.60, p = 0.032). The depersonalization dimension of burnout was predicted by a full-day shift (adjusted β: -7.69, 95%CI: -13.48, -1.89, p = 0.010) and rank of nursing/midwifery officers (adjusted β: 3.57, 95%CI: 1.71, to 6.43, p = 0.015). Personal accomplishment was predicted by casual employment (adjusted β: 5.72, 95%CI: 1.13, 11.31, p = 0.045) (Table 6).

Descriptions of the four QoL domains and the overall QoL of the study participants are presented. The mean overall QoL score of study participants was 78.1 (±8.6). All study participants scored more than 50% (mean score) on all QoL domains. Comparing the four domains of QoL, the social health domain had the highest mean score of 81.2 (±11.7), followed by the environment domain with a mean score of 79.4 (±10.6). The physical health domain had the lowest score, with a mean score of 76.5 (±11.0).

Association between burnout and quality of life of study participants: Table 7 presents the linear regression analysis of the association between burnout dimensions and QoL. Participants' QoL was predicted by moderate burnout for emotional exhaustion (β = -4.59, 95%CI: -4.59, -0.46, p = 0.017) and high burnout for personal accomplishment (β = -6.28, 95%CI: -8.65, -3.91, p < 0.001).

Discussion     

Overall, the prevalence of burnout among the participants in the present study was low (2.9%). The findings of this study underpin initial reports that burnout is rife among nursing professionals in sub-Saharan Africa [31]. The overall prevalence of burnout observed in the present study is consistent with the 2.1% reported among nursing professionals in Kumasi Metropolis [11]. However, the overall prevalence of burnout observed in the present study differs from that (68.6%) reported among nurses in a tertiary medical facility in Nigeria. This discrepancy may be attributed to several factors unique to Ghana´s healthcare context. First, Ghana´s nursing workforce benefits from structured shift rotations and mandated rest periods, which may mitigate chronic exhaustion. Second, cultural attitudes toward work in Ghana often emphasize resilience and communal support, potentially reducing perceived burnout. Third, our study´s use of the full MBI scale (rather than abbreviated versions) and strict scoring thresholds may have identified only the most severe cases, unlike studies that used more lenient criteria [32]. Additionally, Ghana´s nursing education system incorporates stress management training, which may enhance coping mechanisms compared to settings with less formalized support. Variations in burnout rates across studies also stem from methodological differences. Studies reporting a higher prevalence often used single-dimensional tools (e.g., emotional exhaustion only) or dichotomised Likert scales, whereas our MBI-based assessment required high scores across all three dimensions. Contextual factors, such as Ghana´s lower nurse-to-patient ratio (1:6 in study hospitals vs. 1:20 in Malawi) and the absence of active conflict (unlike Uganda), likely further reduce systemic stress. Finally, the timing of data collection (post-COVID-19 peak) may have captured a recovery phase, whereas other studies have reflected acute pandemic stress.

In the present study, high burnout for both depersonalisation (83.6%) was observed compared to the personal accomplishment (61.5%) and emotional exhaustion (54.5%) dimensions. The prevalence of emotional exhaustion observed in this study affirms the initial reports that Ghanaian nurses experience low emotional exhaustion [11,32]. The high level of burnout observed in the present study for both depersonalisation and personal accomplishment was similar to the higher levels of burnout for depersonalisation (71.6%) and personal accomplishment (90.8%) reported among nurses working in a tertiary hospital in Jeddah [30]. The higher prevalence of burnout for depersonalisation is particularly concerning because the depersonalisation dimension of burnout occurs when an employee no longer has an interest in the job and detaches himself/herself from his/her core responsibilities in the workplace. The high depersonalisation experienced by nurses in the present study can affect their contribution to quality delivery in the healthcare system. It is important to encourage nurses who may experience any form of burnout to seek counselling and to pay attention to reducing its incidence in the workplace.

The present study's findings showed that night shifts were associated with the emotional exhaustion dimension, whereas the full-day shift and rank of nursing/midwifery officers were associated with depersonalisation. Casual/contract employment was significantly associated with personal accomplishments.

This study found a significant association between night and full-day shifts, emotional exhaustion, and personal accomplishments. Nurses who predominantly worked full-time shifts exhibited a notable reduction in burnout related to personal accomplishments compared to those who primarily worked morning shifts. Furthermore, nurses whose shifts were mainly at night experienced an expected six-fold increase in emotional exhaustion compared to their counterparts who worked morning shifts. This could be explained by the longer working hours during the night shift than the morning shift. Nurses spend more hours in the workplace during night shifts than during morning shifts, which may increase their stress levels and drain them emotionally. A previous study stressed the need to reduce long working hours to reduce the incidence of burnout in the workplace [33]. A similar study conducted in China found a significant association between working long hours and emotional exhaustion.

These findings are consistent with those of several local and international studies. In Ghana, prior research has demonstrated that nurses working night shifts report elevated levels of fatigue, stress, and emotional strain compared to their counterparts working day shifts, primarily because of sleep disruption and insufficient recovery time [34]. Similarly, studies conducted in other African nations, such as Nigeria and South Africa, have indicated that irregular or extended night shifts significantly exacerbate emotional exhaustion and diminish nurses´ overall well-being [35]. Globally, evidence from China, the United States, and Europe corroborates that long working hours and night shifts are strong predictors of burnout, particularly emotional exhaustion [29].

The underlying reasons for these associations are well-documented. Night shifts frequently entail longer working hours, reduced staffing levels, and increased workloads, which may increase stress and emotional fatigue [36]. Disruption of circadian rhythms limits social support during night duty, and poor sleep quality contributes to elevated levels of exhaustion. In line with these explanations, previous studies have underscored the necessity of reducing long and irregular working hours as a strategy to mitigate burnout in healthcare settings. Similarly, a study conducted in China reported a significant effect of prolonged working hours on emotional exhaustion.

The present study found that nursing and midwifery officers exhibited a threefold increase in depersonalisation levels compared to staff nurses and midwives. This phenomenon may be attributed to the substantial demands placed on nursing and midwifery officers to deliver high-quality services while simultaneously fulfilling supervisory roles, in contrast to staff nurses and midwives who occupy junior positions. The dual responsibilities of clinical and managerial duties can result in increased workload, thereby predisposing officers to burnout through depersonalisation. Similar observations have been documented in China, where a high workload was correlated with an elevated risk of burnout [31], and in Nigeria, where senior nurses experienced heightened levels of depersonalization [37].

The study further identified that nurses employed on a casual or contractual basis exhibited higher levels of burnout related to personal accomplishment than their permanent counterparts. Temporary or contract nurses may be driven to exert greater effort and work extended hours in pursuit of permanent employment, often completing tasks without sufficient rest, resulting in diminished personal accomplishments. This observation aligns with recent studies conducted in Nigeria, Kenya, and Thailand, which indicate that nurses in temporary or contractual roles are more susceptible to burnout due to job insecurity, limited career advancement opportunities, and reduced benefits.

The welfare of every healthcare professional is essential for delivering high-quality medical care. Overall, the QoL of the participants in the present study was high. Participants reported a high QoL in all four domains. However, among the four domains of QoL, participants reported the highest QoL in the social health domain and the lowest in the physical health domain. The high QoL observed among study participants is important for quality healthcare delivery. Nurses play a critical role in providing quality delivery to the healthcare continuum. The high QoL in the social health domain observed in the present study reflects the participants' high level of contentment with social support and peer interaction in their daily lives. This finding is consistent with that of a study in Malaysia, which also observed the highest QoL scores in the social health domain among nurses [38].

In India, a study also reported high QoL scores in the social health domain [39]. More than half of the nurses in this study were married, and having a supportive partner could be one of the variables contributing to a good QoL score for social relationships. More than half of the study participants indicated that they received management support in the workplace, which is also a good recipe for a good QoL in the social health domain. The low QoL scores observed in the physical health domain in the present study could be explained by the notion that nurses concurrently performed the responsibilities of women, mothers, wives, and daughters. These factors can impair physical quality of life and cause fatigue and sleep deprivation. In Poland, a similar study reported that among the four domains of QoL, nurses reported the worst in the physical health domain. In China, a similar study also observed lower QoL scores in the physical domain [39]. However, the physical domain had the worst QoL in the present study, which is in contrast to a study in Australia, where nurses obtained higher scores in the physical health domain.

The present study found that nursing professionals who experienced high burnout for personal accomplishment had expected decreases in overall QoL scores compared to those who experienced low burnout. This finding implies that nursing professionals who experience high levels of burnout due to personal accomplishments have a greater likelihood of reducing their QoL. Nursing professionals assessing themselves as having high burnout for personal accomplishments mean that they see themselves as negative and cannot progress in their professional careers. At this stage, nursing professionals may begin to doubt their ability to progress professionally, thus negatively affecting their well-being. The findings of this study agree with those of earlier studies that reported a significantly negative correlation between personal accomplishments and QoL [40]. Another significant finding of the present study was that participants who experienced moderate burnout levels for depersonalization had an expected decrease in QoL scores by four compared to those who had modest degrees of burnout in the depersonalization dimension. This aligns with previous studies that reported a negative correlation between burnout and QoL [41]. A nursing professional experiencing high levels of depersonalization may detach themselves from colleagues and patients, which can affect the psychological health domain of QoL [42].

Limitations of the study: this study has several limitations that may have affected the interpretation and generalisation of the findings. The cross-sectional design and relatively small sample size of the two district hospitals limited the causal conclusions regarding the relationship between burnout and QoL. Moreover, reliance on self-reported measures could introduce response bias. The absence of longitudinal data hinders the analysis of how these variables evolve over time, and the study did not address potential confounding factors (e.g., workplace support and staffing ratios) or variations in work environments that could influence outcomes. These limitations underscore the need for future research that encompasses larger and more diverse samples, longitudinal designs, and mixed-method approaches that combine both subjective and objective measures to provide more robust evidence for interventions aimed at enhancing nurses´ well-being.

Conclusion     

This study demonstrated that burnout remains an important occupational health concern among nursing professionals in the Ashanti region of Ghana, with meaningful implications for their overall quality of life. Although the overall prevalence of burnout was relatively low, high levels of emotional exhaustion and depersonalisation were evident, underscoring the multidimensional nature of burnout in the nursing workforce. The findings highlight the influence of work-related factors, particularly shift schedules, employment arrangements, and professional rank, on burnout dimensions and QoL outcomes. These results emphasise the need for organizational and systemic responses that go beyond individual-level coping strategies. Considering these findings, the Ghana Health Service and hospital management should prioritise targeted interventions aimed at improving nurses´ working conditions and psychosocial well-being. Optimising shift systems, particularly reducing prolonged night and full-day shifts, may help mitigate emotional exhaustion and depersonalisation. Employment policies that promote job security and fair workload distribution should be strengthened to enhance personal accomplishments and job satisfaction. Additionally, the integration of workplace mental health and staff welfare programs, including counselling services, peer support mechanisms, and stress management training, is recommended. Nursing training institutions and health managers should incorporate occupational health, burnout prevention, and resilience building into their professional development programs. Routine monitoring of burnout and quality of life among nursing professionals is also recommended to inform evidence-based workforce planning and policy adjustments. Strengthening institutional and policy-level responses is critical for improving nurses´ quality of life, enhancing workforce retention, and sustaining the delivery of high-quality healthcare services in Ghana.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

George Wireko Brobby Bonsu developed and designed the concept and collected data; George Wireko Brobby Bonsu, Oscar Vetsi, and Francis Kwantwi-Barima analyzed and interpreted the results; Oscar Vetsi wrote the first manuscript, and Daniel Boateng reviewed all the manuscripts; Kingsley Boakye worked on the methodology. All the authors read and approved the final version of this manuscript.

Acknowledgments     

We are grateful to the respondents who participated in the study and contributed to science through their cooperation. We also thank the Manhyia Government and the Seventh-Day Adventist Hospital for allowing us to use their premises for this study.

Tables     

Table 1: demographic characteristics of study participants in the Ashanti region of Ghana (January 2023 - March 2023)

Table 2: work-related characteristics of study participants in the Ashanti region of Ghana (January 2023 - March 2023)

Table 3: descriptive statistics of burnout dimensions among the study participants in the Ashanti region of Ghana (January 2023 - March 2023)

Table 4: linear regression analysis of factors associated with emotional exhaustion among the respondents in the Ashanti region of Ghana (January 2023 - March 2023)

Table 5: linear regression analysis of factors associated with depersonalization among the study participants in the Ashanti region of Ghana (January 2023 - March 2023)

Table 6: linear regression analysis of factors associated with personal accomplishment among the study participants in the Ashanti region of Ghana (January 2023 - March 2023)

Table 7: linear regression analysis of the association between burnout dimensions and QOL among the respondents in the Ashanti region of Ghana (January 2023 - March 2023)

References