Occupational stress and associated risk factors among nurses: a cross-sectional study

The Nursing Stress Scale-Spanish Version: An Update to Its Psychometric Properties and Validation of a Short-form Version in Acute Care Hospital Settings

Stressful working conditions are correlated with a negative impact on the well-being of nurses, job satisfaction, quality of patient care and the health of the staff. The Nursing Stress Scale (NSS) has been shown to be a valid and reliable instrument to assess occupational stressors among nurses. This study updates the psychometric properties of the “NSS-Spanish version” and validates a short-form version. A cross-sectional design was carried out for this study. A reliability analysis and a confirmatory factor analysis and an exploratory factor analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing and criterion validity confirmed scale equivalence. A total of 2195 Registered Nurses and 1914 Licensed Practical Nurses were enrolled. The original 34-item scale obtained a good internal consistency but an unsatisfactory confirmatory and exploratory factor analysis. The short-form Nursing Stress Scale (11-items) obtained a good internal consistency for Registered Nurses (α = 0.83) and for Licensed Practical Nurses (α = 0.79). Both Nursing Stress Scales obtained a strong correlation for Registered Nurses (rho = 0.904) and for Licensed Practical Nurses (rho = 0.888). The 11-item version of the Nursing Stress Scale is a valid and reliable scale to assess stress perception among Registered Nurses and Licensed Practical Nurses. Its short-form nature improves the psychometric properties and the feasibility of the tool.

When and how do hospital nurses cope with daily stressors? A multilevel study

BACKGROUND

During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses.

OBJECTIVES

To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses.

DESIGN

This study uses descriptive, correlational, two-level design with repeated measures.

SETTINGS

Wards of two University hospitals.

PARTICIPANTS

A random cohort of 113 nurses was studied.

METHODS

An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships.

RESULTS

Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task.

CONCLUSIONS

The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey

AIM

To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events.

DESIGN

Cross-sectional nationwide survey.

METHODS

Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression.

RESULTS

This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards.

CONCLUSIONS

Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events.

IMPACT

Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.

Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis

BACKGROUND

Today, accreditation is considered as the most commonly used health assessment approach. Considering the importance and application of the process of this approach in the hospital, this study aimed to investigate the challenges of implementation of hospital accreditation in Iran using exploratory factor analysis.

METHODS

A cross-sectional study design was carried out from July to December 2017, consisting of 200 managers in the seven hospitals accredited by the MOH in Tehran, Iran. Samples were selected through the purposive sampling method, and data were collected using a structured questionnaire in which validity and reliability were confirmed. Likert's five-choice range was used for the rating of items. Exploratory factor analysis was used to categorize the identified challenges and extract the mathematical model on them.

RESULTS

Exploratory factor analysis identified six dimensions (implementation, evaluation, content, structural, psychological, and managerial) with 40 items using a 5-point Likert scale. Each dimension accounted for greater than 63.20% of the total variance. The scale had strong content validity (indices = 0.84). Each dimension of Cronbach's alpha ranged from 0.74 to 0.94. Implementation, evaluation, content, structural, psychological, and managerial components also formed the final identified areas.

CONCLUSION

The present study showed that there were major challenges in the path to successful deployment of Iranian hospital accreditation, requiring serious action by managers and policymakers in this field.

Quality of work life and factors associated with it among nurses in public hospitals, Iran

BACKGROUND

There is an acute shortage of nurses worldwide including Iran. Quality of work life is important for nurses as it affects the safety and quality of care provided for patients as well as organizational factors. The aim of this study was to describe the status of quality of work life and to explore its predictors among nurses in Iran.

METHODS

A cross-sectional study was conducted on 2391 nurses in 85 Iranian public hospitals, selected through the convenience sampling. Data were collected using demographic information and the quality of work life questionnaires.

RESULTS

The mean score for total quality of work life was 2.58, indicating a low level of self-reported quality of work life, with 69.3% of nurses dissatisfied with their work life. The major influencing factors were inadequate and unfair payment, lack of solving staff problems by organization and poor management support, job insecurity, high job stress, unfair promotion policies, and inadequate involvement in the decision-making. Significant predictors in the multivariate analysis for lower quality of work life were male gender, being single, older age, having lower educational levels, and working in teaching hospitals.

CONCLUSION

The quality of nursing work life was at a low level and needs improvement interventions. The predictors identified allow for more targeted interventions. Nursing managers and policymakers should develop and implement successful strategies appropriately to improve the quality of work life. This includes the payments, organizational and managerial support, job security, fair promotion policies, and measures to reduce job stress.