Psychological Burnout among Professionals Working with Children with Motor Disabilities

Background Psychological burnout is a state of psychological and physical fatigue that shows the effect of work stress on the individual and negatively affects his/her attitudes towards work. The current study was motivated by the assumption that people who work directly with students with special needs are at the forefront of professions that can create feelings of frustration, and thus may be vulnerable to psychological burnout. Objective To identify the level of psychological burnout among professionals working with children with motor disabilities, and how these levels differ according to gender, workplace, years of experience, and the number of children the employees treat. Design The sample comprised 195 staff members at the Al-Hussein Society for the rehabilitation of the Physically Challenged and the Cerebral Palsy Foundation in Amman, Jordan. The researchers used the Maslach Burnout Inventory, which consists of three dimensions: emotional exhaustion, depersonalization, and the lack of a sense of personal accomplishment. Results We found a low level of psychological burnout among those who work with children with motor disabilities. The level of psychological burnout was low for two dimensions: lack of a sense of personal accomplishment and depersonalization, whereas it was average for emotional exhaustion. The results showed statistically significant differences in the degrees of psychological burnout in its three dimensions according to the employee’s workplace, with higher levels at the Cerebral Palsy Foundation. However, no statistically significant differences were found among the participants due to gender, years of experience, or the number of children they treat. Conclusions The low levels of psychological burnout among professionals who work with children with motor disabilities might be due to the psychological and professional support they receive from their institutions.


Introduction
e concept of psychological burnout is of relatively recent origin, having emerged in its modern form during the 1970s in the eld of functional psychology. Freudenberger (1974) was the rst to introduce this concept to refer to the physical and emotional responses resulting from long-term exposure to work stress among sta at a clinic, who had high and unrealistic expectations. Modern life is full of multiple and varied sources of psychological and mental stress, including from people's social, psychological, family, professional, marital, political, and academic lives (Ghoneim & Qatanani, 2011). People at work who do not have enough resources to cope with job demands might be in risk for psychological burnout (Seriwatana & Charoensukmongkol, 2020).
Psychological burnout is one of the most severe incidents to be encountered at work. It is de ned as a group of symptoms of nervous stress, exhaustion of emotional energy, depersonalization, and a sense of dissatisfaction with one's personal achievement in one's professional eld. ese symptoms could occur in people who perform work that requires direct interaction with others (Goddard & Goddard, 2006). Psychological burnout is a state of psychological and physical fatigue that shows the e ect of work stress on the individual and negatively a ects his/her attitudes towards work; it can be clearly diagnosed through the individual's behavior at work (Askar, 2003). Maslach (2003) identi ed three components of psychological burnout: emotional exhaustion, depersonalization, and the loss of a sense of accomplishment. Emotional exhaustion is de ned as the feeling of being psychologically and mentally exhausted. An emotionally exhausted person feels that he/she no longer wants to work. Depersonalization refers to the display of negative attitudes towards everything that relates to work, including coworkers. Lastly, loss of the sense of accomplishment indicates lower levels and loss of motivation and self-con dence at work (Angerer, 2003;Kacem et al., 2020). ese components were re ected by the instrument used in this study.
Individuals whose jobs require considerable contact with others, such as teachers and health-care personnel, may have a high likelihood of experiencing emotional exhaustion (Chaukos et al., 2017). Previous research has shown that emotional exhaustion can have negative e ects both on the employee and the organization (Bakker, Westman, & Schaufeli, 2007). Emotional exhaustion can result in reduced job satisfaction (Shanafelt et al., 2015), inappropriate behavior with coworkers and customers (Kim, 2008), and may lead employees to quit their jobs (Skaalvik & Skaalvik, 2016). In general, psychological burnout may negatively a ect employees' health (Chen & Chen, 2012), job satisfaction, job performance, and organizational commitment (Singh, Goolsby, & Rhoads, 1994). E orts have been made in many societies to train specialists to work in the elds of psychological and social services; however, many of these occupations involve various forms of work stress that prevent such specialists from performing their roles e ectively, which can weaken their e ciency and ability to help others (Al-Zayoudi, 2007). People working in humanitarian jobs, such as nursing, medicine, counseling, social work, and teaching, are particularly prone to psychological burn-out (Keel, 1993). However, those working with people with special needs come at the forefront of professions that can create feelings of frustration. is work requires these professionals to have the skills to deal with various groups of people who su er from physical, mental, auditory, visual, or multiple disabilities. Each person with a disability is a special case who requires a special pattern of service, learning, training, and assistance. In addition, the diversity and severity of their problems may sometimes create among sta a feeling of frustration and a weak sense of achievement, leading to psychological burnout because of these work-related stressors (Al-Farah, 2001). e concept of psychological burnout has drawn the attention of many researchers and scholars. In a study conducted by Al-Shami and Al-Smadi (2020) to investigate burnout among teachers at special education institutions in Jordan compared to teachers working in public schools, they found that the level was moderate among all participants regardless of their workplace. ere were no signi cant di erences in the level of burnout among teachers according to gender, age, or academic quali cation. Similarly, Kharfallah, Balalia, and Sadlib (2019) detected the levels of psychological burnout among 48 people who worked with special needs students. ey found that burnout was high, and that those who worked with students who were intellectually disabled su ered from higher levels of burnout than sta who worked with visually impaired and autistic students.
Abu Mustafa and Al-Zein (2009) conducted a study aimed at identifying the sources of work stress among teachers of children with disabilities in special education institutions in Gaza. ey found that the most common sources of psychological pressure among teachers were their relationship with the children, their salary, promotion, relationship with colleagues, relationship with the parents, working conditions, relationship with managers, and the work environment. Platsidou and Agaliotis (2008) studied psychological burnout among teachers of special education in Greece, nding low levels of burnout among teachers on the three dimensions of the Maslach Burnout Inventory (emotional exhaustion, depersonalization, and sense of personal accomplishment). However, no statistically signi cant di erences were found according to the variables of gender and teaching experience.
In another study, Al-Zahrani (2008) tried to identify the nature of the relationship between psychological burnout and some personality traits of sta working with special needs children in the city of Jeddah, Saudi Arabia. e results showed that employees with 11-15 years of experience had more burnout than those with fewer years of experience. No statistically signi cant di erences in the level of psychological burnout were found according to age, gender, academic quali cation, or marital status. Al-Zayoudi (2007) identi ed the sources of psychological stress and burnout among teachers of special education in Karak Governorate, Jordan. e subjects suffered from di erent levels of psychological stress and burnout ranging from medium to high. Male teachers su ered from emotional stress more than female teachers, and teachers with low experience and low income had higher levels of psychological burnout.
In comparing psychological burnout among teachers of ordinary students, gi ed students, students with severe learning di culties, and students with disabilities, Al-Qaryouti and Al-Khatib (2005) found higher levels of burnout for teachers of gi ed students and students with severe disabilities as compared to teachers of ordinary students and those with learning di culties. No statistically signi cant di erences were found according to gender, academic quali cation, years of experience, or marital status.
Al-Gamali and Hassan (2003) studied psychological burnout among teachers of students with special needs in the Sultanate of Oman. e results showed that the teachers su ered from a moderate degree of burnout, while teachers who worked with students with multiple disabilities were particularly vulnerable to burnout. No statistically signi cant di erences were found in the three dimensions of psychological burnout according to gender and teaching experience.
Finally, Al-Farah (2001) conducted a study of psychological burnout among teachers working with students with special needs in Qatar, and found a medium degree of burnout. e results also showed that specialists in the treatment and training of people with special needs were more vulnerable to burnout than the two categories of teachers in the eld of special education. ere were no statistically signi cant di erences in the level of psychological burnout due to educational level or years of experience. Teachers who work with students with multiple disabilities su ered from depersonalization more than those who work with students with mental disabilities and physical sensory disabilities.

Research Questions
Psychological burnout and its consequences leave negative impacts on the individual, whether in relation to adaptation to or controlling any challenges, which may also extend to include others who interact and communicate with this individual. People who work directly with students with special needs, such as teachers and specialists, or others such as administrators, are at the forefront of professions that can create feelings of frustration. erefore, the current study aimed at revealing the level of psychological burnout among sta who work with people with special needs and motor disabilities in the relevant centers in Amman, Jordan. We also sought to identify the level of psychological burnout among sta in the eld of motor disability according to di erent variables. More speci cally, the current study attempted to answer the following research questions: 1. What is the level of psychological burnout among staff who work with children with motor disabilities? 2. Are there statistically significant differences in the level of psychological burnout among those who work with children with motor disabilities, according to the gender of the staff member? 3. Are there statistically significant differences in the level of psychological burnout among those who work with children with motor disabilities, according to the workplace? 4. Are there statistically significant differences in the level of psychological burnout among those who work with children with motor disabilities, according to their years of experience? 5. Are there statistically significant differences in the level of psychological burnout among those who work with children with motor disabilities, according to the number of children they treat?

Signi cance of the Study
Working with persons with special needs is one of the professions most exposed to psychological burnout. is study is one of the few that has tackled this phenomenon among teachers, specialists, and administrators who work with children with motor disabilities in Jordan. Children with di erent types of disability require a special pattern of service, learning, training, and assistance. erefore, it is of importance to compare burnout among professionals who deal with children with di erent types of disabilities. e ndings of the current study might suggest the need to develop appropriate counseling programs for those who are dealing with children with different types of disabilities, to support them in reducing psychological burnout, and thus to achieve psychological adaptation that would result in better performance. e psychological status of these workers, if stable and controlled, will improve the adaptation and performance of children with motor disabilities academically, developmentally, and socially.

Sampling
e targeted population for this study consisted of all professional employees (N = 215) at Al-Hussein Society for the Rehabilitation of the Physically Challenged, and at the Cerebral Palsy Foundation, in Amman, Jordan. ese two institutions are specialized centers concerned with motor disability, and work under the Supreme Council for Persons with Disabilities in Jordan. e professional employees in these two institutions include: teachers, administrators, specialists, physiotherapists, occupational therapists, doctors, and nurses. e sample comprised 195 sta members who volunteered to participate. Of these, 129 (66%) were females, and 66 were males. Of the study sample, 109 (56%) people work at the Al-Hussein Society and the remaining work at the Cerebral Palsy Foundation.

Instrument
e instrument of this study consisted of two parts. e rst part contains demographic information about the sample, such as: gender, workplace, years of experience, and the number of children the employee treats. e second part consists of the Maslach Burnout Inventory (Maslach & Jackson, 1981), which was used to identify the levels of psychological burnout. is inventory is widely used as a global scale for psychological burnout and has been used in many Arabic and other international studies (Al-Farah, 2001;Al-Gamali & Hassan, 2003;Al-Kharabsheh, 2005;Bataineh & Al-Jawarneh, 2004;Schwarzer & Hallum, 2008;Worley, Vassar, Wheeler, & Barnes, 2008). e inventory consists of 22 items related to the individual's feeling towards the profession. Each participant is asked to respond twice to each item: the rst response indicating a repeat of the feeling (scored on a scale from 0 to 6), and the second one indicating the intensity of feeling (scored on a scale from 0 to 7). ese items are divided into three dimensions: (a) emotional exhaustion: item numbers 1, 2, 3, 6, 8, 13, 14, 16, and 20; (b) depersonalization: items numbers 5, 10, 11, 15, and 22; and (c) lack of a sense of personal accomplishment: item numbers 4, 7, 9, 12, 17, 18, 19, and 21. e score of each participant was calculated for each item, on the three dimensions of the Maslach Burnout Inventory (emotional exhaustion [EE], depersonalization [DP], and lack of a sense of personal accomplishment [PA]), and on the total scale. In interpreting the scores, the following scale was used: 1-2.66 (low), 2.67-4.33 (medium), and 4.34-6 (high).
Reliability of the scores was estimated using Cronbach's alpha, which was 0.85 for the whole scale. Corrected item-total correlations were computed as a measure of the internal consistency of the instrument as provided in Table 1. All values ranged between 0.23 for item 15 and 0.60 for item 8. All corrected item-total correlations exceeded that value of 0.2, which indicated that all items were consistent in measuring psychological burnout.

Data Analysis
To answer our rst research question, we computed the mean and standard deviation for each item, for each dimension, and for the total scale. e t-test and oneway ANOVA were used to detect di erences in psychological burnout among those working with children with motor disabilities, according to gender, workplace, experience, and number of children they treat.

Results
e ndings are presented for each research question sequentially.

First Research Question
To nd the level of psychological burnout among sta working with children with motor disabilities, the mean and standard deviation for each dimension and for the total scale were computed and are presented in Table 1. Table 1 shows that in general, the level of psychological burnout among those working with children with motor disability was low (mean = 2.54, SD = 0.71). e levels of depersonalization and lack of a sense of personal accomplishment were also low (mean = 2.32, SD = 0.85, and mean = 2.36, SD = 0.85, respectively). e level of emotional exhaustion was medium (mean = 2.81, SD = 0.80). To have a better visualization of these results, the mean and standard deviation for participants' score on each item were computed and are presented in Tables 2, 3, and 4. Table 2 shows that study participants had low levels of emotional exhaustion on half of the items (items 13, 3, 8, and 14), with item means ranging between 2.14 for item 14 (I feel that employees blame me for some of the problems they face) to 2.58 for item 13 (Actually, I don't care or take interest in the problems of employees). Medium levels of emotional exhaustion were captured on the other half of the items (items 2, 16, 22, 6, and 1), with item means ranging between 2.66 for item 1 (I feel emotionally drained from practicing this profession ) to 3.67 for item 2 (I feel used up at the end of the workday).  Table 3 shows that people working with children with disabilities had low levels of depersonalization on three items (items 5, 10, and 11), with item means ranging between 1.71 for item 11 (I became cruel with people a er joining this profession) to 2.43 for item 5 (I feel psychological exhaustion from practicing this profession). Levels of depersonalization on the remaining two items (items 15 and 20) were medium, with the item mean of 2.73 for item 20 (I feel happy and comfortable a er working with the employees) and 2.97 for item 15 (I can easily understand employees' feelings about things).  Table 4 shows that the level of lack of a sense of personal accomplishment among those working with children with motor disability was low for all items, except for item 7 (I feel that I work in this profession under great stress), which was medium. e level of psychological burnout was low for items 18, 4, 19, 17, 21, 12, and 9.

Second Research Question
To nd out whether the level of psychological burnout di ers between male and female sta working with children with motor disabilities, an independent samples t-test was carried out on each dimension score and on the total scale scores, as presented in Table 5. e assumption of equality of variances was checked via Levene's test. It was found that variances of the scores for males and females were homogeneous across each dimension.  Table 5 shows that there were no statistically signi cant di erences in the level of psychological burnout between male and female sta working with children with motor disabilities, t = 0.21, p > 0.05. In addition, no statistically signi cant di erences in the level of psychological burnout between male and female sta working with children with motor disabilities were found on the dimensions of emotional exhaustion (t = 0.66, p > 0.05), depersonalization (t = 0.78, p > 0.05), and lack of a sense of personal accomplishment (t = 0.70, p > 0.05).
is indicates that the levels of psychological burnout and the levels of emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment were the same for both male and female sta working with children with motor disabilities.

ird Research Question
To nd out whether the level of psychological burnout di ers among sta working with children with motor disabilities according to their workplace, an independent samples t-test was carried out on each dimension score and on the total scale scores, as presented in Table 6. e assumption of equality of variances was checked via Levene's test. It was found that variances of the scores for workers at the two workplaces were homogeneous across each dimension.  Table 6 shows that there were statistically signi cant di erences in the level of psychological burnout among sta working with children with motor disabilities according to their workplace, t = 3.06, p < 0.01. Sta at the Cerebral Palsy Foundation tended to have higher levels of psychological burnout as compared to those at the Al-Hussein Society. Moreover, workers at the Cerebral Palsy Foundation, as compared to workers at Al-Hussein Society, had statistically signi cant higher levels of emotional exhaustion (t = 3.04, p < 0.01), depersonalization (t = 2.30, p < 0.05), and lack of a sense of personal accomplishment (t = 2.37, p < 0.5).

Fourth Research Question
To nd out whether the level of psychological burnout di ers among sta working with children with motor disabilities according to their years of experience, the mean and standard deviation were computed for each dimension score and for the total scale scores, as presented in Table 7. Table 7 shows that the mean of the scores on the burnout scale and its three dimensions as a function of years of experience ranged from 2.14 to 2.94. In order to examine the statistical signi cance of these di erences, a one-way ANOVA was conducted, and the results are presented in Table 8. Table 8 shows that there were no statistically signi cant di erences in the level of psychological burnout as a function of years of experience (F = 1.74, p > 0.05). In addition, no statistically signi cant di erences were found as a function of years of experience with respect to emotional exhaustion (F = 1.80, p > 0.05), depersonalization (F = 1.39, p > 0.05), and lack of a sense of personal accomplishment (F = 1.33, p > 0.05). is indicates that the level of psychological burnout, emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment did not di er according to the sta members' years of experience. Table 7 Means and standards deviations for score on the burnout scale and its three dimensions as a function of years of experience  Table 8 One-way ANOVA for the psychological burnout scale and its three dimensions as a function of sta members' years of experience

Fi h Research Question
To nd out whether the level of psychological burnout di ers among those working with children with motor disabilities according to the number of children they treat, means and standard deviations were computed for each dimension score and for the total scale scores, as presented in Table 9. Table 9 Means and standards deviations for scores on the burnout scale and its three dimensions as a function of the number of children the sta member treats  Table 9 shows that the mean of the scores on the burnout scale and its three dimensions as a function of years of experience ranged from 2.08 to 2.97. To examine the statistical signi cance of these di erences, a one-way ANOVA was conducted, and the results are presented in Table 10. Table 10 shows that there were no statistically signi cant di erences in the level of psychological burnout as a function of the number of children the employee treats (F = 0.77, p > 0.05). In addition, no statistically signi cant di erences were found as a function of the number of children the employee treats with respect to emotional exhaustion (F = 1.14, p > 0.05), depersonalization (F = 0.73, p > 0.05), and lack of a sense of personal accomplishment (F = 0.88, p > 0.05). is indicates that the level of psychological burnout, emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment did not di er according to the number of children the employee treats. Discussion is study tackled the issue of psychological burnout among professional sta working with children in the eld of motor disability in Jordan, and its relationship to some demographic variables. e exposure of many working in the human and social professions to psychological burnout motivated the study. e results showed that sta working with children with motor disabilities did not su er from psychological burnout. e levels of psychological burnout, depersonalization, and lack of a sense of personal accomplishment were low, although the level of emotional exhaustion was medium. ese ndings agree with those of Platsidou and Agaliotis (2008), which showed that Greek teachers had low levels of psychological burnout on the three dimensions of the scale.
On the other hand, the results of the current study disagree with those of Al-Farah (2001), which showed that psychological burnout among those working with students with special needs in Qatar was at a medium level. In addition, the results of this study disagree with those of Al-Zayoudi (2007), which showed that special education teachers in the Karak Governorate were subject to psychological burnout ranging from medium to high. e low levels of psychological burnout among the sample of this study could be attributed to the type of disability that those working in this eld in Amman confront -motor disabilities -whereas the previous studies were conducted with teachers who work with people with mental, hearing, visual or multiple disabilities. e present study also found no statistically signi cant di erences between males and females in the level of psychological burnout with its three dimensions among those working with children with motor disabilities. is result is consistent with previous studies (Al-Gamali & Hassan, 2003;Al-Qaryouti & Al-Khatib, 2005;Platsidou & Agaliotis, 2008). However, this result disagreed with those of Al-Farah (2001), which indicated that males working with people with special needs are more vulnerable to psychological burnout than females. In the current study, the researchers noted that some male sta members themselves have a motor disability. is could explain the absence of statistically signi cant di erences in the level of psychological burnout in the study sample due to the employees' gender.
According to the workplace, the results of the present study indicated that the level of psychological burnout with its three dimensions was higher at the Cerebral Palsy Foundation than at the in Al-Hussein Society. is result may be attributed to the fact that the Cerebral Palsy Foundation deals with other types of disability, particularly mental disability, in addition to physical disability, while the Al-Hussein Society deals only with people with motor disabilities. e results also found no statistically signi cant di erences in the degree of psychological burnout with its three dimensions according to the employees' years of experience. is result is consistent with previous studies (Al-Farah, 2001;Al-Gamali & Hassan, 2003). However, the results disagree with those of Al-Zayoudi (2007), which indicated that employees with less experience were more exposed to psychological burnout than those with more experience. In addition, the results of this study did not go along with those of Al-Zahrani (2008), which indicated that female teachers with 11-15 years of experience were more exposed to psychological burnout than were other categories of sta . e present study found no statistically signi cant di erences in the degree of psychological burnout with its three dimensions among sta working with children with motor disabilities attributed to the number of children the employee treats. Miller, Brownell, and Smith (1999) indicated that one of the reasons that teachers stop working with people with disabilities is the large number of students. is is not consistent with the results of the present study, which did not show any statistically signi cant di erence in the level of burnout due to the number of children.

Conclusion
e ndings of the present study revealed that the teachers working with children with motor disabilities had low levels of psychological burnout. ese levels did not di er as a function of the teachers' gender, years of experience, or the number of children they treat. is may be a result of the psychological and professional support that these educational and service institutions provide their employees who serve children with motor disabilities. It may also indicate the amount of continuous support through rehabilitation and selection of the best quali ed employees to work in supporting these children. It is hoped that centers that work with children with mo-tor disabilities will extend such support and contribute to alleviating the su ering of these children and their parents.

Limitations
One of the limitations of the current study was related to the sample, which involved only one type of disability, namely motor disability. Future research could study psychological burnout among those working with children with other types of disabilities, in addition to examining the e ects of other variables on psychological burnout, such as educational quali cations, personal characteristics, and monthly income.

Ethics Statement
Participants in the current study were recruited in an ethical manner, and all participants gave informed consent before taking part in the study.