Ethics approval and subjects
The institutional review board approved the 11-item Wellbeing Inventory that was completed by BIS-neurofeedback participants and required signed, informed consent (number: 17–006; June 20, 2018). The institutional review board approved the concomitant completion of the 11-item Wellbeing Inventory and the 20-item PANAS survey and waived the need for consent (number: 18–031; September 27, 2018). The institutional review board approved the concomitant completion of the 5-item Non-burnout Inventory and the 9-item Maslach and waived the need for consent (number: 18–032; October 11, 2018). The completion of the concomitant surveys posed less than minimal risk and the return of a these questionnaires was interpreted as informed consent.
The present study investigated the reliability and construct validity of a wellbeing inventory administered to physicians or nurses working in St. Elizabeth Youngstown Hospital. Analyses of the 11-item Wellbeing Inventory include internal consistency assessment, exploratory factor analysis, confirmatory factor analysis, and concurrent validity correlations with PANAS. Statistical interrogations of the 5-item Non-burnout Inventory include internal consistency assessment, exploratory factor analysis, confirmatory factor analysis, and concurrent validity correlations with PANAS and with Maslach.
Wellbeing inventory survey
For the Wellbeing Inventory, the negative affect items included irritation, nervousness, overreaction, tension, overwhelmed, people too demanding, and drained. The positive affect items included restful sleep, energetic, alert, and enthusiastic. The negative affect and positive affect items were rated as very slightly or none at all, a little, moderately, quite a bit, or extremely according to subjects’ experience over the previous 3 days. The Wellbeing Inventory survey was completed by physicians and nurses who participated in the BIS-neurofeedback study and other physicians and nurses who concomitantly completed Wellbeing Inventory and PANAS surveys.
PANAS survey
For the PANAS, the negative affect items included afraid, ashamed, distressed, guilty, hostile, irritated, jittery, nervous, scared, and upset. The positive affect items incorporated alert, active, attentive, determined, enthusiastic, excited, inspired, interested, proud, and strong. The negative affect and positive affect items were rated as very slightly or none at all, a little, moderately, quite a bit, or extremely according to subjects’ experience over the previous 3 days. The PANAS survey was completed by physicians and nurses who concomitantly completed Wellbeing Inventory and PANAS surveys.
Maslach survey
The abbreviated Maslach emotional exhaustion domain consisted of the following items: 1) I feel emotionally drained from my work; 2) I feel fatigued when I get up in the morning and have to face another day on the job; and 3) working with people all day is really a strain for me. These items were referred to as drained, fatigued, and strained, respectively. The abbreviated Maslach depersonalization component consisted of the following items: 1) I feel I treat some patients as if they were impersonal objects; 2) I have become more callous toward people since I took this job; and 3) I do not really care what happens to some patients. These items were referred to as objects, callous, and do not care, respectively. The abbreviated Maslach personal accomplishment domain consisted of the following items: 1) I deal very effectively with the problems of my patients; 2) I feel I am positively influencing other people’s lives through my work; and 3) I feel exhilarated after working closely with my patients. These items were referred to as effective, positive influence, and exhilarated, respectively. All items were rated as never, few times a year, once a month or less, few times a month, once a week, a few times a week, or every day. The Maslach survey was completed by physicians and nurses who concomitantly completed Non-burnout Inventory and Maslach surveys.
Non-burnout inventory surveys
For the Non-burnout Inventory, the negative affect items included overwhelmed, people too demanding, and drained. The positive affect items included energetic and enthusiastic. The negative affect and positive affect items were rated as very slightly or none at all, a little, moderately, quite a bit, or extremely according to participants’ experience over the previous 3 days.
Factor analyses
A Cronbach alpha coefficient and exploratory and confirmatory factor analyses were conducted to assess the Wellbeing Inventory and Non-burnout Inventory items. For the Wellbeing Inventory confirmatory factor analysis, the 4 positive affect items were coded as 1 for very little or not at all up to 5 for extremely and the 7 negative affect (nonstress) items were coded as 5 for very little or not at all to 1 for extremely. Structural equation modeling was used to model negative affect items and errors as subcomponents of factor 1. Structural equation modeling was used to model positive affect items and errors as subcomponents of Factor 2. The model was composed such that Factor 1 was not related to factor 2.
For the Non-burnout Inventory confirmatory factor analysis, the 2 positive affect items were coded as 1 for very little or not at all up to 5 for extremely and the 3 negative affect items were coded as 5 for very little or not at all to 1 for extremely. Structural equation modeling was used to model negative affect items and errors as subcomponents of factor 1. Structural equation modeling was used to model positive affect items and errors as subcomponents of factor 2. The model was formulated such that factor 1 was not related to factor 2.
Concurrent validity of the PANAS
Correlation coefficient analyses between PANAS and 11-item Wellbeing Inventory negative affect and positive affect scores were performed. The Wellbeing Inventory positive affect score was the sum of the alert, enthusiastic, energetic, and restful sleep scores. The PANAS positive affect score was the sum of the alert, enthusiastic, interested, excited, strong, proud, inspired, attentive, active, and determined scores. The Wellbeing Inventory negative affect score was the sum of the irritated, nervous, overreaction, tension, overwhelmed, people demanding, and drained scores. The PANAS negative affect score was the sum of the irritated, nervous, distressed, upset, scared, guilty, hostile, ashamed, jittery, and afraid scores. The PANAS and Wellbeing Inventory positive affect items were coded as 1 for very slightly up to 5 for extremely. The PANAS and Wellbeing Inventory negative affect items were coded as 1 for very slightly up to 5 for extremely.
Correlation coefficient analyses between PANAS and 5-item Non-burnout Inventory negative affect and positive affect scores were also performed. The Non-burnout Inventory positive affect score was the sum of the enthusiastic and energetic scores. The PANAS positive affect score was the sum of the alert, enthusiastic, interested, excited, strong, proud, inspired, attentive, active, and determined scores. The Non-burnout Inventory negative affect score was the sum of the overwhelmed, people demanding, and drained scores. The PANAS negative affect score was the sum of the irritated, nervous, distressed, upset, scared, guilty, hostile, ashamed, jittery, and afraid scores. The PANAS and Non-burnout Inventory positive affect items were coded as 1 for very slightly up to 5 for extremely. The PANAS and Non-burnout Inventory negative affect items were coded as 1 for very slightly up to 5 for extremely.
Concurrent validity of the Maslach
A correlation analysis was conducted between the Non-burnout Inventory positive affect and negative affect scores and the 3 Maslach domains. The Non-burnout Inventory positive affect score was the sum of the energetic and enthusiastic scores, coded as 1 for very slightly or not at all up to 5 for extremely. The Non-burnout Inventory negative affect score was the sum of the overwhelmed, drained, and people too demanding scores, coded as 1 for very slightly or not at all up to 5 for extremely. The Maslach personal accomplishment score was the sum of the effective, positive influence, and exhilarated scores. The Maslach emotional exhaustion score was the sum of the drained, fatigued, and strained scores. The Maslach depersonalization score was the sum of the objects, callous, and do not care scores. All Maslach items were coded as 0 for never up to 6 for every day.
A second correlation analysis was conducted to assess the relationships between the Non-burnout Inventory total score and Maslach items. The Non-burnout Inventory positive affect score was the sum of the energetic and enthusiastic scores, coded as 1 for very slightly or not at all up to 5 for extremely. The Non-burnout Inventory negative affect score was the sum of the overwhelmed, drained, and people too demanding scores, coded as 5 for very slightly or not at all to 1 for extremely. The Non-burnout Inventory total score was the sum of the Non-burnout Inventory positive affect and negative affect scores. The Maslach personal accomplishment score was the sum of the effective, positive influence, and exhilarated scores, coded as 0 for every day up to 6 for never. The Maslach emotional exhaustion score was the sum of the drained, fatigued, and strained scores, coded as 0 for never up to 6 for every day. The Maslach depersonalization score was the sum of the objects, callous, and do not care scores, coded as 0 for never up to 6 for every day. The Maslach total score was the sum of the personal accomplishment, emotional exhaustion, and depersonalization scores.
Statistical analyses
Results were entered into an Excel 2010 worksheet (Microsoft Corp., Redmond, WA, USA) and imported into the SAS System for Windows, release 9.2 (SAS Institute Inc., Cary, NC, USA). All mean values were accompanied by their standard deviation. SAS was used to perform the CALIS procedure (PROC CALIS), using the maximum likelihood least squares estimation, and the factor procedure (PROC FACTOR) for confirmatory and exploratory factor analyses, respectively. Concurrent validity analyses were assessed in SAS using Spearman Rank-order correlation procedures where the level of significance was p < 0.05.