Stress and coping in Australian nurses: a systematic review

Job strain, sleep and alertness in shift working health care professionals -- a field study

We explored the associations of job strain with sleep and alertness of shift working female nurses and nursing assistants. Participants (n=95) were recruited from the Finnish Public Sector Study, from hospital wards that belonged to the top or bottom quartiles on job strain. Participants' own job strain was at least as high in high-strain group or low in low-strain group as the ward's average. The study included three-week measurements with sleep diary and actigraphy. Psychomotor Vigilance Test (PVT) was performed during one pre-selected morning and night shift and a day off. Sleep efficiency before morning shifts was lower in the high-strain than low-strain group (p=0.03). Low-strain group took more often (72 vs. 45%; p<0.01) and longer naps (62 vs. 35 min; p=0.01) before the first night shift than high-strain group. Difficulties initiating sleep were more common in high-strain group, especially after evening shifts (p<0.01). High-strain group had more often at least one lapse in PVT during the night shift (p=0.02). Average sleep duration (06:49 h) and efficiency (89%) did not differ between these groups. In conclusion, high job strain is associated with difficulties initiating sleep and reduced psychomotor vigilance in night shifts. Shift working contributed to impaired sleep in both high and low job strain group. Individual and organization-based actions are needed to promote sufficient sleep in shift working nurses, especially with high job strain.

Occupational stress and self-rated health among nurses

OBJECTIVE: To analyze the association between job stress and self-rated health among nurses in public hospital emergency units. METHODS: This is a cross-sectional study undertaken through the administration of a self-administered questionnaire in a sample of 134 health professionals, using the brief version of the Job Stress Scale. Descriptive analyses of the socio-demographic, health and work variables were undertaken, as was multivariate analysis through unconditional logistic regression for adjustment of the association between job stress and poor self-rated health, in accordance with potential confounding variables, with a level of significance of 5%. RESULTS: 70% of the interviewees were classified as passive workers or as with high strain. Poor self-rated health was significantly greater among health professionals with high demand and low control, compared to those with low strain, after adjusting for co-variables. CONCLUSIONS: Low control, allied with low demand, can serve as a demotivating factor, contributing to the increase in professional dissatisfaction. It is recommended that institutions should adopt a policy of planning and managing human resources so as to encourage the participation of health professionals in decision-making, with a view to reducing job stress among nurses.

Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors

AIMS AND OBJECTIVES

The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories.

BACKGROUND

Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy.

DESIGN

A cross-sectional survey research was conducted with self-report questionnaires.

METHODS

The Maslach Burnout Inventory-General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study.

RESULTS

The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment.

CONCLUSIONS

Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk.

RELEVANCE TO CLINICAL PRACTICE

Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction.

Is work stress in palliative care nurses a cause for concern? A literature review

Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines.

AIM

The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses.

RESULTS

Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress.

CONCLUSION

Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.

Dealing with troubled conscience in municipal care of older people

Troubled conscience may jeopardize the health of healthcare personnel and, hence, the quality of care provided. Learning more about how personnel deal with their troubled conscience therefore seems important. The aim of this study was to describe personnel’s experiences of how they deal with troubled conscience generated in their daily work in municipal care of older people. Interviews were conducted with 20 care providers and analysed with a thematic content analysis. The findings show that in order to deal with troubled conscience, personnel dialogued with themselves and with others. They took measures in a direction they perceived to be correct, and they expressed a need for distancing and re-energizing. It is of importance to share situations that generate troubled conscience in order to find ways to deal with them. Reconsidering one’s ways of dealing with troubled conscience may give care providers an opportunity to reach consensus within themselves.

Stress, depression, and intention to leave among nurses in different medical units: implications for healthcare management/nursing practice

AIMS

The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan.

METHODS

Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan.

RESULTS

Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments.

CONCLUSIONS

The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

[Study of stress, coping and psychosomatic health among baccalaureate nurses-to-be]

Stress is a risk factor that may endanger our quality of life and health. Certain occupational groups are particularly concerned, such as health care workers.

OBJECTIVE

The present study aimed to investigate the stress load and coping strategies of nurses as well as their psychosomatic health.

METHOD

The questionnaire survey was performed at the University of Szeged. The sample consisted of 208 nursing students (136 part-time and 72 full-time students). The self-completed questionnaire included items of psychosomatic symptoms, coping strategies and stress load.

RESULTS

Persons characterized by high level of stress and more frequent psychosomatic symptoms tended to use inadaptive ways of coping more often; whereas those with a relatively lower stress level and fewer symptoms were not characterized by a more frequent use of active ways of coping but instead a lack of the inadaptive coping strategies.

CONCLUSIONS

The authors concluded that vulnerability of the would-be baccalaureate nurses in this sample was especially high because they even used less effectively the ways of coping that otherwise aimed at both problem solving and maintaining their own health.

Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences

BACKGROUND

Given a worldwide shortage of primary health care workers predicted to worsen, it is vital to address sources of attrition among these professionals. One such source may be work-related musculoskeletal disorders. We aimed to identify risk factors for and functional consequences of work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians.

METHODS

Eighteen of 87 studies identified from an electronic database search met the inclusion and quality criteria.

RESULTS

Job demands, demanding work schedules and physical exposures have the strongest associations with work-related upper quadrant musculoskeletal disorders. Functional consequences included widespread use of prescription and over-the-counter medications and major negative impact on activities of daily living. No studies of midwives were located.

CONCLUSION

High-quality studies of midwives as well as better-designed prospective studies of nurses and physicians are needed. Results of such studies could inform preventive strategies and reduce the contribution of work-related musculoskeletal disorders to attrition.

Helping women but hurting ourselves? Neck and upper back musculoskeletal symptoms in a cohort of Australian Midwives

OBJECTIVE

To determine the prevalence of neck and upper back musculoskeletal symptoms in a group of Australian midwives and explore individual characteristics and workplace exposures associated with these symptoms.

DESIGN

cross-sectional, using data from the Nurses and Midwives e-Cohort Study, a longitudinal, electronic survey of midwives and nurses in Australia, New Zealand and the United Kingdom.

SETTING

data were collected via an online survey in 2006-2008.

PARTICIPANTS

qualified Australian midwives aged 23-70 years.

MEASUREMENTS AND FINDINGS

We undertook descriptive analysis of the sample, calculated prevalence and examined associations between individual and workplace variables and neck and upper back musculoskeletal symptoms. Variables achieving p<0.1 in bivariate analysis were entered simultaneously into logistic regression models. Overall prevalence rates were 48.8% for neck and 28.2% for upper back musculoskeletal symptoms; work-related prevalence was 40.8% (neck) and 24.5% (upper back), comparable to reported rates among nurses and physicians. Presence of symptoms in the adjacent area was associated with greater than a fourfold increased risk for neck and upper back symptoms. Participants with care responsibility for an adult dependent were 36% more likely to report neck symptoms. Current shift work and total physical activity were associated with decreased likelihood of neck and upper back symptoms, respectively. Psychological job demands were only weakly associated with upper back symptoms, possibly because the survey tool could not capture a sufficiently broad range of psychosocial exposures to present a complete picture. A striking finding was that work in awkward postures conferred an increased risk of 35% for neck and nearly 50% for upper back symptoms.

KEY CONCLUSIONS

neck and upper back musculoskeletal symptoms were prevalent in this sample. Both individual and workplace factors were significantly associated with neck and/or upper back symptoms. Psychological job demands and work in awkward postures are potentially modifiable exposures that deserve further examination.

IMPLICATIONS FOR PRACTICE

midwives who are or may become carers for adult dependents should be aware of a possible increased risk for neck symptoms. It may be prudent for midwives and those who employ/supervise them to monitor and, where possible, jointly develop strategies to mitigate psychological job demands. The potential hazard posed by work in awkward postures warrants consideration of how midwives may minimize time spent working in these postures.

Stress in professional care-givers working with patients with dementia: a hypothesis-generating study

BACKGROUND AND AIMS

Caregiving can be extremely stressful, especially when patients' ability to communicate is impaired. While the stress undergone by relatives assisting their loved ones has been widely investigated, fewer data can be found about the stress in healthcare professionals. The aim of this study is to evaluate whether a specific training course could be related to a reduction in the levels of stress of professional care-givers working with patients suffering from dementia.

METHODS

Work-related levels of stress of study participants were evaluated with the Staff Stress Measure Dementia Care Scale, at baseline and four months after completion of an eight-month training course.

RESULTS

We found no significant correlation between care-givers' age, gender, marital status, years of employment or perceived economic status, and their stress levels at baseline. Patients' characteristics were not related with care-givers' stress at baseline. The mean level of stress was significantly reduced (34.64±4.15 vs 26.64±3.82, p<0.001) between baseline and the study endpoint.

CONCLUSIONS

Increased knowledge of management of patients affected by dementia could help professional care-givers to reduce their work-related stress. Our results add to the evidence of the benefit of personnel support in reducing levels of stress at work.

Applying the Neuman Stressor Model for workplace safety

This article applies the Betty Neuman Stressor Model, typically used in nursing education to explain illness causation of the patient, to educating healthcare workers on workplace stressors (i.e., hazards). Prevention strategies for dealing with workplace hazards are discussed in terms of bolstering flexible lines of defense or lines of resistance as described by this stressor model. Key hazards to include in a healthcare safety curriculum or in workplace safety training are provided.