A systematic review of stress and stress management interventions for mental health nurses

“Not Just a Theory”

Purpose: The purpose of this study was to evaluate the effect of training nurses in Jin Shin Jyutsu® self-care methods and to correlate the training with measurement of the nurses’ personal and organizational stress and their perceptions of their caring efficacy for patients. Design: A quasi-experimental, pretest, posttest, and 30- to 40-day posttest design was used. Method: In all, 20 participants received three 2-hour Jin Shin Jyutsu self-care training sessions from a certified Jin Shin Jyutsu self-care trainer (who was also a registered nurse). The training took place over a 1-month period, and participants agreed to practice the self-care daily. Two study instruments, one measuring organizational and personal stress and the second measuring caring efficacy, were completed before the first training, after the last training, and 1 month after the trainings had been completed. Findings: Analysis of data from the Personal and Organizational Quality Assessment–Revised by paired t tests showed significant increases in positive outlook, gratitude, motivation, calmness, and communication effectiveness and significant decreases in anger, resentfulness, depression, stress symptoms, time pressure, and morale issues. Nurses reported less muscle aches, sleeplessness, and headaches. Analysis of the Coates Caring Efficacy Scale measures showed statistically significant increases in nurses’ caring efficacy in areas of serenity in giving care, tuning in to patients, relating to patients, providing culturally congruent care, individualization of patient care, ability to decrease stressful situations, planning for multiple needs, and creativity in care. Conclusions: This small study suggests that Jin Shin Jyutsu self-care may be a valuable tool for nurses, to decrease stress, both emotional and physical, and increase caring efficacy. Administrators may wish to invest in such a program, which may improve quality of care delivered. The Watson caring model, which reminds us that nurses who care for themselves and feel good about their work can better care for others, proved an accurate framework for this study.

Finnish occupational health nurses' view of work-related stress: a cross-sectional study

Occupational stress at work has been increasingly recognized as a major risk factor for chronic disease and poor quality of work life among employees. The purpose of this study was to examine how occupational health nurses in Finland manage work-related stress. A descriptive cross-sectional study design was used with a sample of 354 Finnish occupational nurses who responded to the survey. No specific standardized tools to assess or handle work-related stress in occupational health services or their client companies were identified. Open-ended interviews together with burnout questionnaires were the most frequently used methods to assess the stress of employees. Interventions were directed at individual employees. A need for standardized stress assessment instruments and stress management by work organizations was found. Methods to cope with work-related stress should be developed by the occupational health team and companies' health resources departments to ensure the adoption of common protocols.

Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care

The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.

Emotional intelligence and affective intensity as life satisfaction and psychological well-being predictors on nursing professionals

The goal of this study was to examine the relationship between perceived emotional intelligence (PEI), affective intensity, life satisfaction, and psychological well-being in a sample of nursing professionals. Studies conducted in nursing have shown that emotional intelligence is a skill that minimizes the negative stress consequences. PEI was measured by the Trait Meta-Mood Scale, which includes the emotional attention, clarity and repair subscales. Affective intensity was measured by Larsen's Affective Intensity Scale. To analyze this relationship, we observed the impact of PEI and affective intensity on life satisfaction and psychological well-being, while controlling the sociodemographic variables. The correlation analyses showed significant relationships between the subscales of these variables. Clarity showed positive relationships with some psychological well-being dimensions. Affective intensity subscales presented relationships with life quality and different subscales of psychological well-being. Regression analyses indicated that repair is the only life satisfaction predictor. Moreover, clarity, some affective intensity dimensions, and sociodemographic variables are the main predictors of psychological well-being. The results confirmed the importance of repair on life quality and psychological well-being. Programs to improve nursing professionals' PEI are needed to increase their psychological well-being and life satisfaction.

Exploration of the burnout syndrome occurrence among mental health nurses in Cyprus

Nurses' work-related stress might be associated with psychiatric symptoms, leading to altered professional attitudes. The aim of this study was to explore the levels of burnout and associations with anxiety and depressive symptoms among Greek-Cypriot psychiatric-mental health nurses (PMHNs). A descriptive correlational design with cross-sectional comparisons was applied. A sample of 226 PMHNs was used. Participants reported low levels of burnout. However, 10% of them manifested clinically significant anxiety and depressive symptoms. Emotional exhaustion and depersonalization were associated with depressive (r=0.562, p<0.0001, and r=0.616, p<0.0001, respectively) and anxiety (r=0.394, p<0.0001, and r=0.448, p<0.0001, respectively) symptoms. Further research investigating the biological aetiopathology of these psychological alterations is warranted.

Greek-Cypriot mental health nurses' professional satisfaction and association with mild psychiatric symptoms

The present descriptive correlational study aims to explore among Greek-Cypriot mental health nurses (MHNs) the level of professional satisfaction, potential differences with regard to vocational characteristics, and associations with anxiety and depressive symptoms. A random sample of 225 Greek-Cypriot MHNs employed in hospital and community settings completed Hamilton's Anxiety Scale, Beck's Depression Inventory, and Stamps's Index of Work Satisfaction. Moderate levels of overall professional satisfaction of 4.38 (±0.58) were detected. Work experience was positively correlated with satisfaction from payment (τ = 0.230, P < 0.0001). Men seemed to be more satisfied with organizational policies (P = 0.0043) and performed tasks (P = 0.027) than women. Nurses working in psychiatric clinics of general hospitals experienced higher levels of professional satisfaction in general, and more satisfaction from organizational policies, autonomy, and task requirements than nurses working in community settings, substance misuse programs, and community mental health centres (P = 0.001). Nurses working in acute/admission settings were the less satisfied, compared to nurses working in rehabilitation wards (P = 0.017). Professional satisfaction was associated with anxiety (τ = 0.280, P < 0.0001) and depressive (τ = 0.246, P < 0.0001) symptoms. Greek-Cypriot MHNs seem to get moderate satisfaction from their work, whilst professional satisfaction is associated with their psychological well-being. Targeted managerial interventions and longitudinal research are warranted.

Rehabilitation in Residential Aged Care Facilities: Barriers and Facilitators in a Dementia Context

This review of the literature sought to highlight key barriers to the implementation of rehabilitation-based interventions in an aged care facility context. It then identifies how such barriers might be actively countered with a view to facilitating rehabilitation-based strategies within such contexts. Key barriers identified included staffing issues, heterogeneity of residents, and the potential complexity behind establishing appropriate forms of rehabilitation for the residents. The most successful facilitators identified included training, the provision of appropriate support, and an open communication process. Having an awareness and an appreciation of potential barriers to the use of rehabilitation interventions in aged care facilities provides the opportunity to actively plan around them, thereby increasing and improving their use.

Work-related behaviour and experience patterns of nurses in different professional stages and settings compared to physicians in Germany

Working in a health-care profession is correlated with high levels of stress and potential burnout that are likely to increase over time. Few studies differentiate psychosocial stress between nurses in different clinical settings or professional stages. In this cross-sectional study, we compared the work-related behaviour and experience of nurses (n=389) and physicians (n=344) and of nurses across different career stages and clinical settings in Germany. Nurses had the lowest proportion of a healthy behaviour and experience pattern (11.6%) compared with student nurses (32.6%), senior nurses (25%), and physicians (16.7%). They also had the highest proportion of a burnout-related behaviour and experience pattern (32.8% vs 26.1% of student nurses, 18.3% of senior nurses, and 27.3% of physicians). In comparison with medical nurses, psychiatric nurses presented a significantly (P<0.01) lower proportion with a healthy (10.6% vs 21.8%) and burnout-related behaviour pattern (23.5% vs 29.6%), and a higher proportion showing a low commitment to work (61.4% vs 34.4%). Differences in health-related dimensions were primarily observed in the domains of professional commitment and stress resistance. The observed differences in behaviour and experience patterns as a function of health-care settings and career stages emphasize the need for specific interventions.

Ready, aim fire! Mental health nurses under siege in acute inpatient facilities

It has been clearly acknowledged and well-documented that physical, emotional, and psychological violence is a central theme and an expected workplace hazard for registered nurses working in acute inpatient mental health care facilities. Limited research, however, has focused on how registered nurses have been able to cope within this environment and adequately protect themselves from harm. A critical feminist research project recently explored the lived experience of 13 Australian, female, registered nurses working in a busy metropolitan acute inpatient mental health care facility. "Fear" was exposed as the precursor to violence and aggression, both "fear as experienced by the nurse" and "fear as experienced by the patient." The participants reported experiencing a sense of fear when they could not accurately or confidently anticipate a patient response or reaction. They identified this relationship with fear as being "part of the job" and part of the unpredictable nature of caring for people experiencing complex distortions in thinking and behavior. The participants believed, however, that additional workplace pressures complicated the therapeutic environment, resulting in a distraction from patient care and observation. This distraction could lead to nurse-patient miscommunication and the potential for violence. This article discusses a major theme to emerge from this study, "Better the devil you know!" The theme highlights how mental health nurses cope with violence and why they choose to continue working in this complex care environment.

The art of mental health practice: the role of drama in developing empathy

PURPOSE

This paper explores concepts central to acting, and details how these concepts can be related to mental health nursing practice.

DESIGN AND METHODS

The work of the acting theorists Constantin Stanislavski and Lee Strasberg is examined and recontextualized to illustrate how their work is relevant in modern mental health practice, and the development of empathy.

FINDINGS

While these concepts are still utilized in drama, they have not been fully explored in their original context. Their use could combat stress and burnout, heighten awareness, and enhance the projection of emotions.

PRACTICE IMPLICATIONS

These concepts can be linked with reflective practice in mental health, and a stronger emphasis on the values of this approach could allow the nurse to strengthen the level of empathy they demonstrate.

Occupational stress and psychopathology in health professionals: an explorative study with the multiple indicators multiple causes (MIMIC) model approach

Occupational stress is a multivariate process involving sources of pressure, psycho-physiological distress, locus of control, work dissatisfaction, depression, anxiety, mental health disorders, hopelessness, and suicide ideation. Healthcare professionals are known for higher rates of occupational-related distress (burnout and compassion fatigue) and higher rates of suicide. The purpose of this study was to explain the relationships between occupational stress and some psychopathological dimensions in a sample of health professionals. We investigated 156 nurses and physicians, 62 males and 94 females, who were administered self-report questionnaires to assess occupational stress [occupational stress inventory (OSI)], temperament (temperament evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire), and hopelessness (Beck hopelessness scale). The best Multiple Indicators Multiple Causes model with five OSI predictors yielded the following results: χ2(9) = 14.47 (p = 0.11); χ2/df = 1.60; comparative fit index = 0.99; root mean square error of approximation = 0.05. This model provided a good fit to the empirical data, showing a strong direct influence of casual variables such as work dissatisfaction, absence of type A behavior, and especially external locus of control, psychological and physiological distress on latent variable psychopathology. Occupational stress is in a complex relationship with temperament and hopelessness and also common among healthcare professionals.

Mindfulness Interventions to Reduce Stress among Nursing Personnel

Workplace stress within health care settings is rampant and predicted to increase in coming years. The profound effects of workplace stress on the health and safety of nursing personnel and the financial impact on organizations are well documented. Although organizational modification can reduce some sources of stress, several unique stress-producing factors inherent in the work of nursing personnel are immutable to such approaches. Mindfulness training, an evidence-based approach to increase situational awareness and positive responses to stressful situations, is an inexpensive strategy to reduce stress and improve the quality of nurses' work lives. Several approaches to training, such as mindfulness-based stress reduction, can be tailored to health care settings. Considerations for occupational health nurses in incorporating mindfulness training as an aspect of a comprehensive work site health promotion program for nursing and other hospital personnel are discussed.

Occupational stress and implementation of information technology among nurses working on acute psychiatric wards

PURPOSE

The study describes nurses' occupational stress and implementation of information technology on acute psychiatric wards.

DESIGN AND METHODS

The sample consisted of 146 Finnish nurses. The data were collected using a structured questionnaire in 2006.

FINDINGS

Eleven percent of the nurses felt that work was very mentally strenuous and 45% felt that it was rather mentally strenuous. Male nurses reported more stress and dissatisfaction than female nurses. Nurses with very positive attitudes towards Internet use reported less stress and more job satisfaction than nurses with neutral attitudes towards Internet use.

PRACTICE IMPLICATIONS

By supporting positive attitudes to information technology in nurses' daily work, we may increase their job satisfaction and thereby reduce their stress experiences.

Stress and stressors in the clinical environment: a comparative study of fourth-year student nurses and newly qualified general nurses in Ireland

AIMS AND OBJECTIVES

To measure and compare the perceived levels of job-related stress and stressors of newly qualified nurses and fourth-year student nurses in the clinical environment and to explore the participants' views on stress and stressors.

BACKGROUND

Stress in the nursing workplace has significant consequences for the person, the patient and the organisation, such as psychological and physical health deterioration and impaired professional practice. To address this problem, stress and stressors need to be measured and identified.

DESIGN

This study used a cross-sectional survey design and self-reporting questionnaires to measure and compare levels of stress in both groups. Convenience sampling involved all newly qualified nurses (n = 120) and fourth-year student nurses (n = 128) in Dublin North-East region in Ireland.

METHODS

The instrument used was 'The Nursing Stress Scale' (Gray-Toft & Anderson 1981, Journal of Behavioral Assessment 3, 11-23). Descriptive, qualitative analysis was conducted on an open-ended question. Data were obtained from newly qualified nurses (n = 31) and fourth-year student nurses (n = 40) in six acute hospital sites.

RESULTS

Levels of perceived stress and stressors were high in both groups. Themes identified from the responses to the open question by both groups included excessive workload, difficult working relationships and unmet clinical learning needs. Student nurses also reported the combination of academic demands with clinical placement as a major stressor. There was no significant difference between each group.

CONCLUSION

Stress continues to be a problem for nurses in the clinical setting. Excessive workload requires urgent attention by hospital managers in view of widespread retention difficulties. Themes identified could provide a framework for possible interventions for improving the clinical environment for nurses.

RELEVANCE TO CLINICAL PRACTICE

These results can help stakeholders in nurse education and practice to develop interventions to reduce stress for both groups and to ease the transition from student to graduate nurse.

The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit

PURPOSE

The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes.

DESIGN AND METHODS

A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used.

FINDINGS

The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care.

PRACTICE IMPLICATIONS

Increases in patient satisfaction and decreases in patient safety events were found.

[Prevention of burnout by stress management]

Burnout is a possible consequence of excessive demands, high levels of stress, or a consequence of lack of resources for coping with difficult tasks. Systematic stress management might be effective in reducing the risk for development of a burnout syndrome. Based on a literature search on available research papers and meta-analyses in Medline and Pubmed, current findings on the content and effectiveness of stress management programs are reported for different target groups. Stress management programs can be divided into programs focusing on primary, secondary, and tertiary prevention. In contrast to primary prevention programs, secondary and tertiary preventive programs focus on the specific needs of different target groups. Cognitive-behavioral programs have been shown to be the most effective interventions. A combination of psycho-educational treatment with follow-up or booster sessions increases the long-term outcome in the prevention of burn-out syndromes. Beside the duration of the program, focus on problems and sustainability of supply is important for the long-term effectiveness in secondary and tertiary prevention.

Does clinical supervision promote medical-surgical nurses' well-being at work? A quasi-experimental 4-year follow-up study

AIM

The aim of the present paper is to report results of a quasi-experimental study exploring the effects of clinical supervision (CS) on the development of medical-surgical nurses' well-being at work over a 4-year period.

BACKGROUND

Effective workplace interventions are needed to prevent stress and burnout. More robust scientific evidence is needed to confirm the restorative effects of CS in nursing.

METHODS

A questionnaire survey on the perceptions of work and health was conducted in 2003 and 2007 on 14 units of a Finnish university hospital where 19 CS group processes had been completed between 2004 and 2007.

RESULTS

Improvement in job resources as well as reduction in professional inefficacy and psychological distress were found among nurses who received effective CS (n = 41), but were not present among the nurses who found their CS less effective (n = 43) or who did not attend CS (n = 82).

CONCLUSIONS

The results provide robust evidence for the positive effects of CS on medical-surgical nurses' well-being at work.

IMPLICATIONS FOR NURSING MANAGEMENT

Stress is a developmental challenge in the professional growth of individual nurses. One option for management to sustain nurses' well-being at work is to develop a learning organization in the workplace making use of CS.

Stress of Conscience among psychiatric nursing staff in relation to environmental and individual factors

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff.

Psychosocial interventions in workplace mental health promotion: an overview

A review based on the DataPrev final report concerning workplace mental health promotion is presented. Out of 4865 studies identified in a comprehensive bibliographical data search, 315 were selected for abstract screening and 79 were included in the final review. The studies were categorized in terms of their aims/expected outcomes and evaluated for quality on the grounds of their design and type of analysis. The most frequent aims were stress reduction and better coping, followed by increased job satisfaction and effectiveness, mental health enhancement and reduction in mental health-related absenteeism. In the 79 intervention studies, 99 outcome variables were measured using 163 instruments, mostly developed for the study purposes. Different intervention categories turned out to be used to attain the same aim, with skills training being the most popular (other approaches included improvement of occupational qualifications and working conditions, physical exercise, relaxation and multicomponent interventions). Among the few intervention programs that were implemented and evaluated in two or more studies, the Stress Inoculation Training (Cecil and Forman, in Effects of stress inoculation training and coworker support groups on teachers' stress. Journal of School Psychology, 28, 105, 1990) based on the model by Meichenbaum (Meichenbaum, in Stress Inoculation Training. Pergamon Press, New York, 1985) seemed to be the most promising. Its effectiveness, evidenced in a majority of the measures, was evaluated in studies using the randomized controlled design. This paper is illustrated by high-quality intervention studies. In high and moderate quality studies, positive effects were reported in about a half of the examined outcome variables. However, conclusive evidence of intervention programs effectiveness would require further research-repetition of studies using treatments equivalent to the experimental ones, and outcome evaluation taking into account other criteria, e.g. behavioural.

Evaluation of a Brief Intervention to Improve the Nursing Care of Young Children in a High HIV and AIDS Setting

The HIV epidemic in South Africa is putting great strain on health services, including the inpatient care of young children. Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional well-being, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the postintervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support.

Investigating the impact of psychosocial risks and occupational stress on psychiatric hospital nurses' mental well-being in Japan

A cross-sectional survey was conducted, with the aim to examine what stressors in the workplace and demographic factors were associated with signs and symptoms of poor well-being among psychiatric nurses. A structured questionnaire was distributed to nurses within six psychiatric hospitals in Japan. Information was collected on demographic information, work characteristics and two dimensions of well-being: feeling uptight and emotional exhaustion. Three hundred and sixty-one questionnaires were completed by participants. High rates of emotional exhaustion in psychiatric nurses were found to be predicted by young age, high psychological demands paired with low social support in the workplace, job strain (a proxy to occupational stress) and job strain paired with low social support. In addition, high rates of being tense/uptight were associated with high psychological job demand, low psychological job control, low social support in the workplace, high job strain and high job strain paired with low social support. The current study has found evidence of significant relationships between demographic factors and several work and organizational stressors and poor mental health among Japanese psychiatric nurses.

Revalidation of the Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.

A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism

Background. Psychosocial stressors in the workplace are a cause of anxiety and depressive illnesses, suicide and family disruption. Methods. The present review synthesizes the evidence from existing systematic reviews published between 1990 and July 2011. We assessed the effectiveness of individual, organisational and mixed interventions on two outcomes: mental health and absenteeism. Results. In total, 23 systematic reviews included 499 primary studies; there were 11 meta-analyses and 12 narrative reviews. Meta-analytic studies found a greater effect size of individual interventions on individual outcomes. Organisational interventions showed mixed evidence of benefit. Organisational programmes for physical activity showed a reduction in absenteeism. The findings from the meta-analytic reviews were consistent with the findings from the narrative reviews. Specifically, cognitive-behavioural programmes produced larger effects at the individual level compared with other interventions. Some interventions appeared to lead to deterioration in mental health and absenteeism outcomes.Gaps in the literature include studies of organisational outcomes like absenteeism, the influence of specific occupations and size of organisations, and studies of the comparative effectiveness of primary, secondary and tertiary prevention. Conclusions. Individual interventions (like CBT) improve individuals' mental health. Physical activity as an organisational intervention reduces absenteeism. Research needs to target gaps in the evidence.

Interventions following a critical incident: developing a critical incident stress management team

This article describes the development and implementation of a stress management model for assisting hospital staff after critical incidents using an adaptation of Mitchell's model (J. Mitchell, 1983). A survey was conducted following the first major incident using M. Horowitz, N. Wilner, and W. Alvarez's (1979) Impact of Event Scale 10 days after and again 6 weeks following the incident to measure its emotional impact on staff. Outcomes included being symptom-free of critical incident stress after a 3-month period. The interventions were intended to help staff at a large metropolitan multispecialty hospital in Queensland in the immediate period following critical incidents. The implications of this program indicated the importance of emotional support at critical times for health professionals.

Occupational stress, social support, and quality of life among Jordanian mental health nurses

Occupational stress affects physical and mental health of mental health nurses. This study measured levels of occupational stress and identified the variables that are associated with occupational stress among Jordanian mental health nurses. A descriptive design was conducted, using self-report questionnaires and demographic characteristics. Data were collected from 181 mental health nurses who were recruited from all mental health settings in Jordan. Jordanian mental health nurses showed high levels of occupational stress regarding "client-related difficulties," "lack of resources," and "workload." The highest level of social support as indicated by these Jordanian mental health nurses was from a spouse/partner followed by colleagues. Regarding quality of life (QOL), physical health scores were higher than mental health scores. Occupational stress correlated significantly and negatively with QOL-physical scores, QOL-mental scores, and social support scores, and correlated positively with being physically assaulted, verbally assaulted, and the respondent having the intention to leave his or her current job. Social support, QOL-mental scores, verbal assault, ward type, and intention to leave the current job were the best predictors of occupational stress among Jordanian mental health nurses. Mental health nurses are under significant occupational stress levels; therefore, comprehensive interventions aimed at minimizing the risk of occupational stress and improving social support and quality of life among mental health nurses are needed.

Psychosocial work environment and prediction of job satisfaction among Swedish registered nurses and physicians - a follow-up study

In Sweden, the health care sector was subject to considerable changes during the 1990s: decreased costs, related staff redundancies and high rates of sick leave. The situation has now changed, and the sector is not facing the same all-embracing and turbulent changes. In addition, there is a shortage of nurses and physicians and a difficulty in retaining qualified staff. Regarding the psychosocial work environment, there is a lack of studies where both physicians and nurses are in focus. It is from a managerial perspective important to take a holistic approach towards questions regarding the work environment in general and the psychosocial work environment in particular. The aims of this study were to analyse similarities and differences in Registered Nurses and physicians' experience of quantitative and qualitative demands, control, role conflicts, role clarity, social support and job satisfaction in 2002 and 2009 and to analyse the stability in the prediction of job satisfaction over time. Questionnaires regarding psychosocial work environment aspects were distributed in 2002 and 2009, and a total of 860 nurses and 866 physicians answered the questionnaire. Independent t tests and linear stepwise regression analyses were conducted. The results indicate that the work environment has improved between 2002 and 2009 and that nurses experience their psychosocial working environment as more satisfactory than physicians. Social support, control, role conflicts, role clarity and qualitative demands were the best predictors of job satisfaction in 2002 and 2009. Quantitative demands did not contribute to predicting job satisfaction. Variables predicting job satisfaction are quite stable over time and are quite comparable for both nurses and physicians.

Work related stress and European policy--a comparative exploration of contextual stressors in the rehabilitation sector in five European countries

BACKGROUND

Dealing with work related stress is a declared priority of European Union mental health policy. A particularly under-researched sector in this regard is the community vocational support sector for people with mental health and intellectual disability problems.

AIMS

To report on the organisational profile of the vocational support and rehabilitation sector for people with mental health and intellectual disabilities as this relates to occupational stress, in five European countries (Austria, Ireland, Italy, Romania and UK).

METHODS

A sector profile questionnaire was distributed to representative organisations in five countries and a short face-to-face survey was conducted with 25 local managers (five from each country) to draw up a profile and facilitate a comparative description and analysis.

RESULTS

It was found that there is no national and European data collected at any level in this sector upon which to base effective policy interventions to combat occupational stress specific to professionals working in this sector. Results indicate that the sector in a number of the countries sampled does not have effective mechanisms in place to deal with occupational stress.

CONCLUSION

Developing effective transnational occupational stress management policy that supports staff working in this sector and measuring its success is greatly impaired by a failure to effectively define the purpose of the sector and collect and collate national data to support it.

Developing a web-based stress management intervention for occupational support workers

BACKGROUND

Occupational support workers in the mental healthcare sector are exposed to considerable occupational stress and have little access to stress management facilities.

AIMS

This article describes the process behind creating a web-based stress management intervention (SMI) for occupational support workers in the mental healthcare sector.

METHOD

Mixed methods were used to inform the content of the web-based SMI, following MRC strategy for designing interventions and PRIMA-EF guidelines for best practice in SMI design. We conducted a literature review to ascertain the content of interventions that had been shown to be successful in reducing stress in mental healthcare populations. In addition, we conducted focus groups in order to assess specific stressors that individuals in the occupational support sector deemed to be important.

RESULTS

The literature review showed that a variety of methods had been successful for reducing occupational stress in the mental healthcare sector including: Relaxation and Cognitive Behavioural Therapy techniques, and skills training in; time management, problem-solving and communication. Individuals in the focus groups identified both personal and organisational stressors to be addressed in the intervention.

CONCLUSIONS

This intervention was developed with reference to a design strategy, using input from the target population.

Using internal marketing to improve organizational commitment and service quality

AIM

The purpose of this article was to explore the structural relationships among internal marketing, organizational commitment and service quality and to practically apply the findings.

BACKGROUND

Internal marketing is a way to assist hospitals in improving the quality of the services that they provide while executing highly labour-intensive tasks. Through internal marketing, a hospital can enhance the organizational commitment of its employees to attain higher service quality.

METHOD

This research uses a cross-sectional study to survey nursing staff perceptions about internal marketing, organizational commitment and service quality. The results of the survey are evaluated using equation models. The sample includes three regional hospitals in Taiwan. Three hundred and fifty questionnaires were distributed and 288 valid questionnaires were returned, yielding a response rate of 82.3%. The survey process lasted from 1 February to 9 March 2007. The data were analysed with SPSS 12.0, including descriptive statistics based on demographics. In addition, the influence of demographics on internal marketing, organizational commitment and service quality is examined using one-way anova.

RESULTS

The findings reveal that internal marketing plays a critical role in explaining employee perceptions of organizational commitment and service quality. Organizational commitment is the mediator between internal marketing and service quality.

CONCLUSION

The results indicate that internal marketing has an impact on both organizational commitment and service quality. Internal marketing should be emphasized to influence frontline nursing staff, thereby helping to create better organizational commitment and service quality.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

BACKGROUND

The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.

METHODS

93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.

RESULTS

The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.

CONCLUSIONS

The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Mental health nursing and stress: maintaining balance

The recruitment and retention of mental health nurses within acute inpatient mental health facilities continues to be an ongoing issue. Literature and current research highlight an environment fraught with pressure and stress, identifying several key factors contributing to job dissatisfaction. These factors include greater patient acuity, unpredictable and challenging workspaces, violence, increased paperwork, and reduced managerial support. This qualitative, critical, feminist exploration investigated the lived experiences of 13 female mental health nurses working in inpatient services. They were asked about their practice and perceptions of workplace culture, and they shared their thoughts on stress management and professional well-being. Positive workplace practice was highlighted, and the participants revealed an environment they were proud to be a part of. Individual interviews, focus groups, and reflective practice were all used to collect data. The findings from the investigation unanimously support current literature that clearly confirms mental health nursing to be stressful. Interestingly, however, the findings also clearly identified that the way in which the nurse participants managed their stress was intrinsically linked to their job satisfaction. The major theme identified throughout the present study revealed that the female participants' ability to manage an at times complex workspace through the notions of teamwork, diversity, and creativity. All of the participants considered these elements as significant to providing a high standard in patient care. This research might provide an opportunity for others to view mental health nursing from a different perspective, and through the lived experiences of the participants, embrace the positive and rewarding aspects of the role.

Mental strain among staff at medical rehabilitation clinics in Germany

Objectives: The aim of the study is to compare the frequency of mental strain effects on employees in somatic and psychosomatic rehabilitation clinics as well as between the different occupational groups. Associations between mental strain effects and working conditions, cooperation in the team and employee satisfaction are also investigated.

Methods: The present study is cross-sectional with a descriptive-explorative design. It is composed of a survey with standardized questionnaires (Human Service Workload, Questionnaire on Teamwork and Questionnaire on Staff Satisfaction in Medical Rehabilitation) and global items, and was conducted among all employees of twelve rehabilitation teams (five somatic and seven psychosomatic rehabilitation clinics (n=549)). The response rate of the survey averaged 45% (n=252).

Results: One in four participants reported being emotionally exhausted. There were significantly more emotionally exhausted employees working in the psychosomatic (31%) than in the somatic rehabilitation clinics (16%) (X²=7.403, df=1, p<0.05), with physicians most frequently reporting emotional exhaustion (45%). The negative appraisal of mental strain effects is accompanied by negative values for cooperation in the team and employee satisfaction (r=–.38 to r=–.50, p<.001). There were mostly high correlations (r=–.503 to r=–.609) between the working conditions and the mental strain effects (emotional exhaustion, intrinsic motivation, dissatisfaction).

Conclusions: The results clearly show that the employees in medical rehabilitation clinics have a high stress level at work, a situation which is also known in other health care organizations. Observations of strong associations between cooperation in the team and strain effects confirm the positive impact of social support in the daily work routine. Correlation between the subjective appraisal of working conditions and the impact of strain is mostly high. It can be assumed that the strain effects can be influenced positively with supportive team and human resource development (person-related interventions) and interventions that enhance working conditions (condition-related interventions).

Work/life balance and health: the Nurses and Midwives e-cohort Study

BACKGROUND

Nursing and midwifery are demanding professions. Efforts to understand the health consequences and workforce needs of these professions are urgently needed. Using a novel electronic approach, the Nurses and Midwives e-cohort Study (NMeS) aims to investigate longitudinally Australian and New Zealand nurses' and midwives' work/life balance and health. This paper describes NMeS participation; provides key baseline demographic, workforce and health indicators; compares these baseline descriptions with external norms; and assesses the feasibility of the electronic approach.

METHODS

From 1 April 2006 to 31 March 2008, nurses in Australia and New Zealand, and midwives in Australia were invited to participate. Potential participants were directed to a purpose-built NMeS Internet site, where study information was provided and consent sought. Once obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited.

RESULTS

Overall, 7633 (2.3%) eligible nurses and midwives participated (6308 from Australia and 1325 from New Zealand) from a total pool of 334,400. Age, gender, occupational and health profiles were similar between countries and to national figures. However, some differences were noted; for instance, Queensland participants were over-represented, while Victorian and South Australian participants were under-represented, and 28.2% of Australians were in high strain positions compared with 18.8% of New Zealanders.

CONCLUSIONS

Using an internationally novel web-based approach, a large cohort, which appears generally similar to population norms, has been established. Provided participant retention is adequate, the NMeS will provide insight into understanding the drivers of nurses' and midwives' workforce retention and work-related factors associated with their health.

Perceived stress among nursing staff in psychiatric inpatient care: the influence of perceptions of the ward atmosphere and the psychosocial work environment

The aims of this study were to investigate (1) perceived stress as felt by the nursing staff working in psychiatric inpatient care, (2) possible differences between nurses and nurse assistants, and (3) associations among individual characteristics, the ward atmosphere, the psychosocial work environment, and perceived stress. Ninety-three members of the nursing staff completed three instruments--one each measuring perceived stress, the ward atmosphere, and the psychosocial work environment. There were no differences among the staff groups concerning perceived stress. Multivariate analysis showed that the ward atmosphere factor "Involvement" and the psychosocial work environment factor "Role Clarity" were indicators of perceived stress. Improvements in these factors could help to prevent stress among the staff.

Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic

Background

In recent years an increasing number of patients have been referred to the medical sector with stress symptoms. Moreover, these conditions imply increased sickness absence. This indicates a need for treatment programmes in general medical practice. The aim of this study was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW) rate in persons with work-related stress and establish predictive factors for this outcome.

Methods

During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational Medicine) completed a stress treatment programme consisted of the following:

1) Identification of relevant stressors. 2. Changing the coping strategies of the participants. 3. Evaluating/changes in participant workload and tasks. 4. Relaxation techniques. 5. Physical exercise. 6. Psychiatric evaluation when indicated by depression test score.

On average each patient attended six one-hour sessions over the course of four months.

A group of 34 employees referred to the Clinic of Occupational Medicine by their general practitioners served as a control group. Each participant had a one-hour consultation at baseline and after four months. A specialist in occupational medicine carried out all sessions.

Return To Work (RTW), defined as having a job and not being on sick leave at the census, was used as outcome measure four months after baseline, and after one and two years.

Results

The level of sick leave in the stress treatment group dropped from 52% to 16% during the first four months of follow-up and remained stable. In the control group, the reduction in sick leave was significantly smaller, ranging from 48% at baseline to 27% after four months and 24% after one year. No statistically significant difference between the two groups was observed after one and two years. Age below 50 years and being a manager increased the odds ratio for RTW after one and two years, while gender and depression had no predictive value.

Conclusions

The stress treatment programme showed a significant effect on the return to work rate. The stress treatment programme seems feasible for general practitioners.

Trial Registration

ISRCTN04354658

Mental health nurses' and allied health professionals' perceptions of the role of the Occupational Health Service in the management of work-related stress: how do they self-care?

Higher rates of stress-related sickness are found in health care professionals when compared with other sectors. The annual direct cost of absence to the National Health Service is £1.7 billion. Increased clinical demand, long hours, low staffing and a lack of support from colleagues and management are contributing to absenteeism, somatic complaints and mental health problems. Mental health work is inherently stressful and levels of work stress experienced by mental health nurses are especially high. The study investigated mental health nurses' and allied health professionals' (AHPs) awareness and knowledge of the service provided by the Occupational Health Service (OHS) and identified work-related stress and self-care strategies within these two groups. Nurses and AHP staff employed in mental health services in a Scottish healthboard area were invited to complete an anonymous questionnaire. Results demonstrated that staff found their contact with the OHS to be a positive experience. They considered direct patient care to be less stressful than the organizational constraints they work under, and they reported a lack of support from both their peer groups and management. There should be recognition of the increased stress that hospital-based nurses and AHPs experience. These areas should be scrutinized and reviewed further to support staff within these environments in accordance with organizational objectives.

Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision: an interview study

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in group-based supervision and identifying psychosocial reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses.

An exploratory study of resilience and job satisfaction among psychiatric nurses working in inpatient units

The present exploratory study was designed to examine the relationship between resilience and job satisfaction in psychiatric nurses working in inpatient units in a large, urban medical centre. The long range goal was to understand the dimensions of job satisfaction in this inpatient environment in order to implement nurse retention programmes specifically targeted toward teaching nurses skills in developing resilience. The nurses (n = 32) reported a high level of resilience and high job satisfaction. The job satisfaction subscale of professional status had the highest mean rating among these nurses, and the physician-nurse interaction subscale had the lowest mean score. Implications for future practice and research are addressed.

Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND

Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.

METHODS

A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).

RESULTS

(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.

CONCLUSION

The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

Self-perceived stress reactivity is an indicator of psychosocial impairment at the workplace

Background

Work related stress is associated with a range of debilitating health outcomes. However, no unanimously accepted assessment tool exists for the early identification of individuals suffering from chronic job stress. The psychological concept of self-perceived stress reactivity refers to the individual disposition of a person to answer stressors with immediate as well as long lasting stress reactions, and it could be a valid indicator of current as well as prospective adverse health outcomes. The aim of this study was to determine the extent to which perceived stress reactivity correlates with various parameters of psychosocial health, cardiovascular risk factors, and parameters of chronic stress and job stress in a sample of middle-aged industrial employees in a so-called "sandwich-position".

Methods

In this cross-sectional study, a total of 174 industrial employees were assessed for psychosocial and biological stress parameters. Differences between groups with high and low stress reactivity were analysed. Logistic regression models were applied to identify which parameters allow to predict perceived high versus low stress reactivity.

Results

In our sample various parameters of psychosocial stress like chronic stress and effort-reward imbalance were significantly increased in comparison to the normal population. Compared to employees with perceived low stress reactivity, those with perceived high stress reactivity showed poorer results in health-related complaints, depression, anxiety, sports behaviour, chronic stress, and effort-reward imbalance. The educational status of employees with perceived low stress reactivity is higher. Education, cardiovascular complaints, chronic stress, and effort-reward imbalance were moderate predictors for perceived stress reactivity. However, no relationship was found between stress reactivity and cardiovascular risk factors in our sample.

Conclusions

Job stress is a major burden in a relevant subgroup of industrial employees in a middle management position. Self-perceived stress reactivity seems to be an appropriate concept to identify employees who experience psychosocial stress and associated psychological problems at the workplace.