Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff

Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis

BACKGROUND

Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers.

METHODS

This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45-60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman's conventional content analysis approach.

RESULTS

The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses.

CONCLUSIONS

The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.

Quantifying emergency department nursing workload at the task level using NASA-TLX: An exploratory descriptive study

BACKGROUND

Emergency departments (ED) nurses experience high mental workloads because of unpredictable work environments; however, research evaluating ED nursing workload using a tool incorporating nurses' perception is lacking. Quantify ED nursing subjective workload and explore the impact of work experience on perceived workload.

METHODS

Thirty-two ED nurses at a tertiary academic hospital in the Republic of Korea were surveyed to assess their subjective workload for ED procedures using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Nonparametric statistical analysis was performed to describe the data, and linear regression analysis was conducted to estimate the impact of work experience on perceived workload.

RESULTS

Cardiopulmonary resuscitation (CPR) had the highest median workload, followed by interruption from a patient and their family members. Although inexperienced nurses perceived the 'special care' procedures (CPR and defibrillation) as more challenging compared with other categories, analysis revealed that nurses with more than 107 months of experience reported a significantly higher workload than those with less than 36 months of experience.

CONCLUSION

Addressing interruptions and customizing training can alleviate ED nursing workload. Quantified perceived workload is useful for identifying acceptable thresholds to maintain optimal workload, which ultimately contributes to predicting nursing staffing needs and ED crowding.

Assessing unsafe behaviors and their relationship with work-related factors among EMS staff in Iran: a cross-sectional study

BACKGROUND

Emergency Medical Services (EMS) staff often encounter various safety incidents. Work-related factors can lead to unsafe behaviors and safety incidents. This study assessed unsafe behaviors and their relationship with work-related factors among EMS staff.

METHODS

This descriptive-correlational study used census sampling method to select 284 EMS staff in Ardabil Province, northwest of Iran, from April to June 2023. The data collection tools were demographic and occupational information form, Mearns Unsafe Behavior Scale, Cohen Perceived Stress Scale, Michielsen Fatigue Scale, and Patterson Teamwork Scale. The data were analyzed using the SPSSv-16, descriptive statistics, Pearson correlation, and multiple linear regression.

RESULTS

The mean of unsafe behavior, fatigue, perceived stress, non-conflict of teamwork, and conflict of teamwork were 15.80 (± 4.77), 20.57 (± 6.20), 16.10 (± 6.13), 117.89 (± 17.24), and 40.60 (± 9.59), respectively. Multiple linear regression analysis showed that "partner trust and shared mental models (PTSMM)," "physical fatigue," "age," "type of shift," "employment status," and "overtime hours per month" were predictors of general unsafe behavior (P < 0.001) and "mild task conflict (MTC)," "employment status," "partner trust and shared mental models (PTSMM)" were predictors of unsafe behavior under incentives EMS staff (P < 0.001).

CONCLUSION

The present study showed that some work-related factors were predictors of unsafe behaviors. The negative consequences of unsafe behaviors should be considered, and long-term planning should be done to reduce them. Developing specific guidelines for addressing unsafe behaviors, implementing measures to reduce fatigue, managing overtime hours in the workplace, and Establishing a system where novice staff work with experienced staff during their first year can be beneficial in reducing these behaviors among EMS staff.

Perceptions of professional challenges by emergency medical services providers: a qualitative content analysis study

INTRODUCTION

Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers.

MATERIALS AND METHODS

This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method.

RESULTS

Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services CONCLUSION: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field.

Factors Influencing Occupational Stress Perceived by Emergency Nurses During Prehospital Care: A Systematic Review

Objective

To assess personal and work-related factors influencing the stress levels of nurses during prehospital care. Specifically, to identify associations between the level of perceived stress, the degree of professional experience, and the level of knowledge. Secondly, to examine the relationship between stress levels and violence in the work environment. And third, to investigate the main protective factors against work-related stress during prehospital care.

Methods

Systematic review in PubMed, WOS, Enfispo, Cochrane, and LILACS databases following the PRISMA methodology (last search 08/Aug/2023). Following the PECO framework, studies on occupational stress factors in ambulance emergency nurses were investigated. Studies in English or Spanish, from 2013 to 2023, and only research articles were admitted, thus excluding reviews, dissertations, and grey literature. Possible bias and level evidence were assessed using critical appraisal tools and GRADE. This protocol was registered in PROSPERO with code CRD42023446080.

Results

Fourteen articles were selected, and n=855 prehospital nurses were identified. One study was a clinical trial, and the others were observational and qualitative. The level of evidence was very low (n=7), low (n=6), and moderate (n=1); any study was excluded due to methodological bias. Five categories of stressors were extracted: the management of the health service (ie, workload organisation, and resources), patient care (mainly paediatric care), interpersonal stressors (relationship with peers), environmental factors (exposure to injuries), and personal factors (training, experience, and coping strategies). Violence at work is frequent for prehospital nurses, implying both verbal and physical aggressions. Support from peers was associated with positive results against stress.

Conclusion

Managing workload and improving resources in the work environment are essential to reduce fatigue and allow emotional processes to be addressed. Providing workers with coping skills also imposes on them the responsibility to cope with stress. Collective awareness is the main element in reducing the incidence of stress.

Role stress, occupational burnout and depression among emergency nurses: A cross-sectional study

BACKGROUND

Emergency nurses are a professional group at a high risk of burnout and depression. This may influence their mental state and physical health.

AIMS

The aim of the study was to explore the relationship between role stress, occupational burnout and depression among emergency nurses.

METHODS

A cross-sectional study was carried out among 295 emergency nurses from eight tertiary hospitals in western China. The Role Stress Scale, the Maslach Burnout Inventory-Human Services Survey and the Center for Epidemiologic Studies Depression Scale were employed. Descriptive statistics, independent sample t-tests, one-way analysis of variance, Pearson's correlation analysis and regression analysis were performed.

RESULTS

Of the study participants, 54.6% were found to have depressive symptoms and 48.1% had severe occupational burnout. Positive correlations were observed between the scores of role stress and burnout and depression. Approximately 37.1% of the variation in depression was explained by the components of occupational burnout.

CONCLUSIONS

Emergency nurses experience high levels of role stress, occupational burnout and depression. Preventive approaches to role stress, burnout and depression are needed to improve their psychological condition and quality of work life.

Traumatic and Routine Stressors in Emergency Nurses: A Turkish Validity and Reliability Study

INTRODUCTION

Emergency nurses face traumatic and stressful events of many different forms and severity. The aim of this study is to test the validity and reliability of the Traumatic and Routine Stressors Scale on Emergency Nurses in Turkey.

METHODS

This methodological study was conducted with 195 nurses who had been working in the emergency service for at least six months and could be reached via an online questionnaire. Opinions of 9 experts were obtained with the translation-back translation method for linguistic validity, and the Davis technique was used for testing content validity. Test-retest analysis was used to test the time-invariance of the scale. Construct validity was evaluated with exploratory and confirmatory factor analyses. The reliability of the scale was evaluated based on item-total correlation and Cronbach's alpha coefficients.

RESULTS

The expert opinions were found to be in agreement with each other. Factor analysis results were acceptable, the Cronbach's alpha coefficients of the scale were 0.890 for the frequency factor, 0.928 for the impact factor, and 0.866 for the total scale. It was determined that the correlation values for the time-invariance of the scale were 0.637 for the frequency factor and 0.766 for the effect factor, and the scale had good test-retest reliability.

DISCUSSION

The Turkish version of the Traumatic and Routine Stressors Scale on Emergency Nurses, has high levels of validity and reliability. We recommend that the scale be used to evaluate the state of being affected by traumatic and routine stressors among emergency service nurses.

Emotional labor and job satisfaction among nurses: The mediating effect of nurse-patient relationship

Emotional labor is considered an important part of the role in the nursing field. Previous studies have found inconsistencies between emotional labor and job satisfaction of nurses, this is due to the relationship between them being affected by other factors. However, the current nurse-patient relationship is tense and leads to an unsafe and unstable working environment for nurses. It has yet to be confirmed whether the nurse-patient relationship can be used as a mediating variable to further explain the association that exists between emotional labor and job satisfaction. Therefore, this study tested the mediating effect of the nurse-patient relationship between emotional labor and job satisfaction among Chinese nurses. A total of 496 nurses were included in the study. Data collection was from December 2021 to March 2022 using the convenience sampling method. SPSS 26.0 and AMOS 23.0 software were used to perform structural equation modeling and analyze the relationship between variables. The results showed surface acting negatively affected nurse-patient relationships and job satisfaction, contrary to deep acting and naturally felt emotions. The parallel mediation of nurse-patient trust and patient-centered nursing in the relationship between emotional labor and job satisfaction was found to be statistically significant. Our study highlighted the important mediation of nurse-patient trust and the importance of the positive effects of emotional labor. Future studies can use these findings as a reference to develop interventions.

Occupational stress of physicians and nurses in emergency departments after contracting COVID-19 and its influencing factors: a cross-sectional study

Background

Occupational stress is one of the major occupational health hazards globally. This study investigated the current situation of and factors influencing the occupational stress of physicians and nurses in emergency departments (EDs) after contracting coronavirus disease (COVID-19).

Methods

An online questionnaire survey was conducted among physicians and nurses in EDs in China between January 5 and 8, 2023. A general descriptive analysis of variables was conducted, the differences in the occupational stress of physicians and nurses in EDs with different characteristics were analyzed using the chi-square test, and factors influencing occupational stress were investigated using generalized ordinal logistic regression.

Results

Of the 1924 physicians and nurses in EDs who contracted COVID-19, 64.71% considered their occupational stress high or very high, with overly intense work as the primary stressor. Those with ≥ 10 years of work tenure, working in tertiary hospitals and with higher professional titles were more stressed, while females, nurses, those with a master's degree or higher, and those who continued to work after contracting COVID-19 were less stressed. There were differences in the predictors of occupational stress between physicians and nurses.

Conclusion

China's physicians and nurses in EDs had high occupational stress after contracting COVID-19. Attention should be given to the occupational mental health of physicians and nurses in EDs, and training on the prevention and treatment of COVID-19 infection should be strengthened.

The influence of changes in the Chinese COVID-19 prevention and control policies on mental health of medical staff: A network analysis

BACKGROUND

Shortly after the first outbreak of COVID-19 in Wuhan, the disease spread rapidly around the world. Previous findings reported an increase in mental health problems among Chinese medical staff, but there was a lack of research following changes in COVID-19 prevention and control policies.

METHODS

Medical staff were recruited separately in China from 15 to 16 December 2022 (N = 765, wave 1) and from 5 to 8 January 2023 (N = 690, wave 2). All participants completed the assessments of Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Euthymia Scale. Network analysis was used to explore the relationships between symptoms both within and across depression, anxiety and euthymia.

RESULTS

Medical staff showed worse anxiety, depression and euthymia at wave 2 than at wave 1. Depression, motor, restlessness and uncontrollable worrying showed high centrality (i.e., strength, expected influence, closeness) at wave 1, but higher at peak. Meanwhile, motor symptoms and restlessness showed the strongest connection between different mental disorders at both wave 1 and wave 2. The network structure was stable over time after the relaxation of the infection policy.

LIMITATIONS

Our participants were not a random sample and the assessments were based on self-reports.

CONCLUSIONS

This study indicated the changes in central and bridging symptoms in medical staff at different stages after lifting of restrictions and the withdrawal of testing requirements, which provided management suggestions for the Chinese government and hospitals, as well as clinical guidance for psychological interventions.

Perceived stress and coping strategies among emergency department nurses and emergency medical services staff during the fifth wave of COVID-19 in Iran: A cross-sectional correlational study

Background and Purpose

Emergency department (ED) nurses and emergency medical services (EMS) staff as the main parts of care on the front line of treatment during the outbreak of COVID-19 experienced great challenges in their work and life, which caused them a lot of stress. Since limited studies have investigated perceived stress and coping strategies among ED nurses and EMS staff in Iran, this study was conducted to investigate perceived stress and coping strategies among ED nurses and EMS staff during the outbreak of the fifth wave of COVID-19 in Ardabil, Iran.

Materials and methods

This descriptive-analytical cross-sectional study was conducted on 327 ED nurses and EMS staff in 2021. The samples were selected by convenient sampling method, and data were collected by demographic and perceived stressors and coping strategies against the outbreak of COVID-19 questionnaires. Data were analyzed by SPSS (version 22) using descriptive (frequency, percentage, mean, and standard deviation) and analytical (Pearson correlation, t-test, and ANOVA) statistical tests and multiple linear regression analysis.

Results

The most stressful factors were related to the transmission of the disease to the family and seeing the death of COVID-19 patients in front of their eyes. The most commonly used coping strategies were strict personal protective measures for all hospitalized patients and the use of clothes that the hospital prepared separately to reduce the transmission of the virus. The results of multiple linear regression showed employees' emotions (β = 0.429, p < 0.001), gender (β = 0.225, p < 0.001), coping strategies (β = 0.209, p < 0.001), stress-reducing factors (β = 0.124, p = 0.014), worry (β = -0.182, p < 0.001), and workplace (β = -0.149, p = 0.045) were effective predictors of perceived stress.

Conclusion

Coping methods such as following strict personal protective measures, using special clothes, and seeing the recovery status of patients and colleagues were effective factors in reducing the perceived stress of health workers. Therefore, it is necessary to provide health workers with training on coping strategies and psychological support in the current crisis and possible epidemics in the future.

Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner's theory

Introduction

Emergency department (ED) nurses and emergency medical technicians (EMTs) find themselves performing triage under time pressure and with limited information. Identifying an effective triage decision-making process can play a significant role in promoting patient safety. Experts are able to make faster and more effective decisions in emergencies than novices.

Objective

The current study aimed to identify the level of triage decision-making (TDM) and its’ predictors in ED nurses and EMTs based on self-reported levels of nursing proficiency in Benner’s theory from novice to expert.

Materials and methods

Out of 821 ED nurses and EMTs who met the inclusion criteria, 320 ED nurses and 152 EMTs were included in this descriptive-analytical research. Data were collected by a demographic information form and triage decision-making inventory (TDMI) and analyzed by SPSSv.22 software using descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression.

Results

The total score of TDMI in the ED nurses and EMTs was higher in the expert nurses than in the proficient, competent, advanced beginner and novices. Multiple linear regression analysis showed that self-reported levels of nursing proficiency, age, work experience, marital status and triage training course were predictors of TDM in ED nurses (P < .05), and self-reported levels of nursing proficiency, service location, work experience, and triage training course were predictors of TDM in EMTs (P < .05).

Conclusion

Understanding the predictors influencing TDM health professionals may facilitate the understanding of their training needs. The training needs of a novice and inexperienced person may be different from those of an expert person, it is recommended that the training methods be based on the experiences and professional levels of nurses so that the training provided is effective and quality. Moreover, to increase the TDM power and reduce TDM errors due to lack of experience, a system is suggested to be established to allow novice nurses in the first year to work with experienced nurses. Also it is suggested that the determining educational and training focus with regards to triage before entering the bedside be done based on predictors.

Predictors of problem-solving skills among emergency medical services staff in Iran: A cross-sectional correlational study

Background and aims

Pre-hospital emergency technicians face many problems in the workplace daily, so the ability to solve or overcome them in the workplace is essential. This article aimed to assess the predictors of problem-solving skills among emergency medical services staff in Iran.

Methods

This study was cross-sectional correlational research. Using convenience sampling methods, 140 emergency medical services (EMS) staff were enrolled in the study. Response time was assessed using ASAYAR software, problem-solving skills (PSS) were measured using the Hepner Petersen Problem Solving Questionnaire (PSI), and cognitive emotion regulation strategies were assessed using the Garnfsky Cognitive Emotion Regulation Questionnaire. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multiple linear regression analysis were applied using SPSS 14.0.

Results

The results of our study showed that the total mean score for problem-solving skills was 136.84 (14.65) (range, 175–107 points). Multiple linear regression indicated that refocusing on planning, positive evaluation, stress management courses, delays and their causes, positive refocusing, catastrophizing, and acceptance were effective predictors of problem-solving skills in emergency personnel, accounting for 54% of the total variances.

Conclusion

This study is one of the first studies in this field. Based on our findings, individuals who consider their emotions and feelings when solving problems are better able to use the process of thinking and problem-solving skills. Therefore, by training people in the field of emotional regulation skills, the skills to solve problems technicians can be increased.