THE EFFECT OF FAMILY SUPPORT ON NURSES’ BURNOUT LEVEL: A CROSS-SECTIONAL STUDY

Background : Nurses experience burnout due to high workloads and various job demands. Family support is one of the factors which influences the levels of burnout. Purpose: To examining the effect of family support on the burnout levels faced by inpatient unit nurses at Blambangan Hospital. Methods: This study was conducted quantitatively with a cross-sectional study design. It took place in December 2022 at Blambangan Hospital. Respondents were 136 inpatient unit nurses. Both primary and secondary data were collected, which included a survey using the Maslach Burnout Inventory questionnaire. This research instrument was tested for validity and reliability. The research data was analysed using a simple linear test with SPSS 23. Results: Based on the results of the linear regression equation, it is discovered that family support positively influences burnout among nurses in the inpatient unit of Blambangan Hospital. In addition, family support has an effect of 6% on burnout in nurses; meanwhile, 94% of burnout is influenced by other unexamined variables. Conclusion: Family support reduces burnout levels among nurses. Therefore, it is necessary to form crucial stress management strategies to reduce burnout for nurses by fostering the family support system.


INTRODUCTION
A study (Humas Fkui 2020) shows nurses have twice the risk of burnout since they are healthcare workers who interact directly with patients for an extended period.Nurses have a significant role in helping patients to recover and restore health and even saving patients' lives.Inpatient nurses must have the competence to meet all the needs of patients, work professionally fast, and have a high spirit of independence while still having good teamwork skills in carrying out nursing care.The increased workload of nurses makes this job highly vulnerable to work stress.In addition, nurses are expected to work by shift system and spend significant time accompanying the patients.Putting all together, many tasks and demands could lead to work-related stress among nurses, possibly decreasing their performance (Maros and Juniar 2016).
Freudenberg initially introduced the term burnout in 1974.Burnout is a chronic stress syndrome experienced physically, mentally, and emotionally due to high work demands (Prestiana and Purbandini 2012).Burnout is commonly experienced among medical professionals, including psychologists, doctors, and nurses (Anggraini and Chusairi 2022).Data from Persatuan Perawat Nasional Indonesia (PPNI) also supported the results of this study, in which 51% of the nurses suffered dizziness, fatigue, work stress, and lack of resting time caused by high workloads (Mariyanti and Citrawati 2011).This aligns with the research conducted by Hardiansyah (2019) that the majority (74.5%) of nurses in the Bhayangkara Sartika Asih Hospital Bandung Hospital experienced burnout.Meanwhile, previous research on ten inpatient nurses at Blambangan Banyuwangi Hospital also discovered that nurses had levels of burnout, namely physical and psychological fatigue, due to high workloads.
Multiple internal and external factors influence the experience of burnout.The internal factors consist of gender, personal behavior, self-esteem, and level of fatigue at work; meanwhile, the external factors include the lack of job promotion opportunities, education level, inappropriate wages, and social support.Social support is defined as experiences in which individuals feel valued, respected, cared for, and loved by family, friends, and teachers (Yasin and Dzulkifli 2010).Impact on social support makes individuals feel more capable of dealing with unpleasant things and will reduce stress.Social support can provide a feeling of being loved and valued, minimizing burnout.Conversely, if a person fails to obtain social support, it can affect the emergence of tension and increase the occurrence of burnout.Khan and Zafar ( 2013) stated that social support can be received from superiors, colleagues, and family.Based on research conducted by Bunga, Simamora, and Deniati (2022), there is a significant correlation between social support for burnout syndrome in nurses.Given these, our study focused on examining the effect of family support on the burnout levels faced by inpatient unit nurses at Blambangan Banyuwangi Hospital.

METHOD
This research was conducted quantitatively using a cross-sectional study design.It was conducted in December 2022 at the Blambangan Regional General Hospital (RSUD) Banyuwangi.A total of 136 inpatient unit nurses were recruited.Online questionnaires were distributed via the WhatsApp group, which contains all members of the inpatient nurses at RSUD.Family support was the independent variable, and burnout level was the dependent variable.Both primary and secondary data were collected for these variables.The secondary data came from RSUD supporting data, including the profiles of the hospital and the nurses' data.At the same time, the primary data was obtained through the Maslach Burnout Inventory (MBI) questionnaire, which consisted of ten aspects with 22 items to measure burnout levels, and the Social Provisions Scale (SPS).Meanwhile, measuring the family support variable consists of 5 aspects, each of which has two items; all the questionnaires were tested for reliability and validity.Data analysis was carried out through multiple linear regression tests with SPSS 23.Based on the frequency distribution of the socio-demographic characteristics of the respondents, it is known that most of the inpatient nurses in this study were female (n =102).This could affect the presence of significant differences in work fatigue or burnout.Furthermore, from the aspect of the education level, more than half of the respondents had an associate degree (D4)/bachelor's degree (S1) as their educational background (n=91).
Meanwhile, in terms of employment status, most respondents (n=81) were civil servants.Therefore, it is essential to know that nurses' educational background and employment status could influence the assignment of responsibilities at RSUD.A reliability test is used to determine whether the instrument that has been made is reliable or can be relied upon when making measurements.Usually, reliability is rated between 0.00 and 1.00; the closer to 1, the higher the instrument's reliability.In this study, Cronbach's Alpha coefficient value for the family support and burnout variables was> 0.60.Based on the test results, it is known that all questions on the variable are reliable and belong to the coefficient criteria with very high reliability.Based on the previous equation ( 1), it is known that the value of x1 (family support) is 0.275, indicating that family support has a beneficial effect on burnout in inpatient unit nurses at Blambangan Regional General Hospital Banyuwangi.Furthermore, at the inpatient unit of Blambangan Regional General Hospital Banyuwangi, it is known that r2 has a value of 0.06 in the linear regression equation, which suggests that there was up to 94% of influence from other variables.Meanwhile, as much as 6% of family support impacts burnout levels among nurses in our study.

DISCUSSION
The results of this study indicated that family support has a positive influence on the occurrence of burnout among inpatient unit nurses at Blambangan Banyuwangi Hospital.These results were on par with the research conducted by Adawiyah (2013), which stated that family support has a close relationship with the occurrence of burnout in a person.Given the tremendous workload and the fact that Blambangan Hospital is the largest regional hospital with significant mobility, nurses in the inpatient unit at that facility are very likely to experience burnout.According to the study (Ramdan and Fadly 2016), family support significantly impacts the incidence of burnout in nurses.One will need social assistance to deal with circumstances and incidents that drain and depress the psyche.Based on another research by Tipandjan and Sundaram (2012), family support has a significant relationship with burnout in nurses at Puducherry General Hospital in India.A person can be more resistant to pressures that might lead to burnout with the aid of family members and close friends.These findings concur with Khalafi, Tangestani, and Osanloo (2014), which found that social support from family and friends reduces the likelihood of stress and burnout in nurses.Moreover, (Halawa 2021) also stated there was a significant relationship between family support and burnout for nurses.It means that the higher the support provided, the lower the burnout level experienced by nurses.Workers who receive much support are less likely to experience stress than those who do not (Ramdan and Fadly 2016).Therefore, it is https://doi.org/10.51602/cmhp.v6i1.104http://cmhp.lenterakaji.org/index.php/cmhpessential to notice that the lack of family support among workers may lead to burnout (Gungor 2019).
The high prevalence of burnout in workers is still a serious health problem that needs special attention from related parties because it will affect productivity levels.Burnout conditions will result in nurses experiencing ongoing stress due to work pressure.
Derealization, emotional weariness, and personal achievement are the key factors.Derealization is the unpleasant conduct of coworkers or patients, emotional weariness results from the enormous burden nurses bear, which causes emotional instability, and personal achievement is the propensity for nurses to be unhappy with the outcomes (Guillermo A et al. 2015).A variety of circumstances can trigger burnout, including internal (personal issues) and external (environmental issues) (Putra and Muttaqin 2020).Social support, mainly provided by the nearest relatives, is one external aspect that can aid nurses in overcoming burnout.This situation arises because nurses under pressure will require assistance from their environment to help them with their issues.
Family support is just one of the various available types of social support.The primary defense or guard against the demands and hardships of modern life may be the support of one's family.Because there is attention and understanding, which indirectly results in a sense of comfort, value, and belonging to one another, the high level of family support achieved will promote psychological well-being (Labiib 2013).This assertion is equal to the findings of a study by Khalafi, Tangestani, and Osanloo (2014), which demonstrated the significance of family support in reducing burnout and work stress among healthcare professionals, particularly nurses.Burnout will result from prolonged stress situations that are not treated, affecting the decline in work output.Compared to workers who do not receive family support, the social support a person gets will foster a sense of belonging and self-confidence.A person's high social support system, especially from the family, will indirectly create a healthy and fit soul and be more enthusiastic about work (Dalimunthe, Suroyo, and Asriwati 2021).Family support is an excellent coping effort for work-related stress and can neutralize burnout (Puspitaningrum 2018).
Even though the result of this research has limitations in terms of its generalisability as it was only conducted among the inpatient nurses at Blambangan Hospital, it is one of the pilot studies to examine the effect of social support on burnout syndrome among local nurses in Indonesia.

CONCLUSION AND SUGGESTION
Based on the results of this research, it was found that family support positively influences the incidence of burnout in inpatient unit nurses at Blambangan Banyuwangi Hospital.Family support had an effect of 6% on the incidence of burnout in nurses, and the rest was influenced by other factors not examined.Therefore, one of the policy implications to be shared with the hospital is to form crucial stress management strategies to reduce burnout for nurses by fostering the family support system.Besides that, it can also develop several programs, such as personal counseling and education about stress management.It is also suggested to increase the research sample by covering all aspects of the health workers in Blambangan Banyuwangi Hospital.Thus, it is more evenly distributed and represents the entire population of existing health workers.

ACKNOWLEDGMENT
The researcher would like to thank as much as possible to the Blambangan Banyuwangi Hospital, especially the respondents, namely the nurses in the inpatient unit who have contributed to this research.It resulted in the process of

Table 2 .
Results of the Family Support and Burnout Questionnaire Validity Test.

Table 4 .
Simple Linear Regression Test Results of Family Support Variable with Burnout Rate in Inpatient Unit Nurses at Blambangan Regional General Hospital Banyuwangi.