Validity-Reliability of a Burnout Scale


Empirical Articles

Assessing Burnout in Portuguese Health Care Workers who Care for the Dying: Validity and Reliability of a Burnout Scale Using Exploratory Factor Analysis

Carol Gouveia Melo*a, David Oliverab

[a] Centre for Professional Practice, University of Kent, Chatham, United Kingdom. [b] Wisdom Hospice, Rochester, United Kingdom.

Abstract Aims: The aim of this study was to develop an effective instrument to measure levels of burnout in Health Care Workers (HCWs) who care for dying patients and confirm the validity and reliability of the scale. The Burnout scale for workers who care for dying patients was created in 2005, by Gouveia Melo, using items from the Maslach Burnout Inventory (Human Services Survey) (Maslach, Jackson, & Leiter, 1997), the Burnout Test (Service Fields) (Jerabek, 2001) and items specifically designed for burnout in end-of-life care. Method: The scale was validated with 280 HCWs working in oncology hospitals and in community home care in different parts of the country. The psychometric methods used were exploratory factor analysis using principal components analysis (PCA), Cronbach’s α coefficients, and intra-class correlation coefficients. Results: The initial 40 items were submitted to analysis for suitability of the data and 38 items were chosen for PCA. Results showed 3 main components with 36 items explaining a total of 34.29% of the variance. These factors were emotional exhaustion (15 items), professional fulfillment (14 items) and depersonalization (7 items). Cronbach’s α coefficients were .86 for emotional exhaustion, .83 for professional fulfillment and .63 for depersonalization. Pearson bivariate correlations were performed on the 150 participants, with an interval of 4 months for test-retest purposes with intra-class correlations from .55 to .59 in each domain. Convergent and divergent validation showed significant correlations. Conclusions: The validity and reliability of this scale was established, enabling it to be used within the Portuguese population.

Keywords: burnout, scale, validation, palliative care, oncology

Psychology, Community & Health, 2012, Vol. 1(3), 257–272, doi:10.5964/pch.v1i3.21

Received: 2012-06-24. Accepted: 2012-09-07. Published: 2012-11-30.

*Corresponding author at: Rua Gil Vicente 12, Bloco C R/C, 2775-198 Parede, Portugal, email:

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Health care workers who care for dying patients are in daily contact with physical degradation, suffering and inevitable death. This is a source of stress that is often more present in this field of medical action than in other medical care areas. Research has shown that health care workers (HCWs) who care for terminal patients can also suffer from death anxiety and that this may lead to burnout affecting the quality of patient and family care (Bernard & Creux, 2003; Connelly, 2009; Keidel, 2002; Lowry, 1997). The underlying causes may be the HCWs’ own fear of death, feelings of inadequacy, insufficient understanding of the needs of dying patients, and difficulties in communicating (Keidel, 2002; Lowry, 1997).