Work-related stress and work ability among Croatian university hospital midwives

The impact on midwives and their practice after caring for women who have a traumatic childbirth: A systematic review

BACKGROUND

Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question.

METHODS

Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes.

RESULTS

A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down".

CONCLUSIONS

Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).

Secondary traumatic stress and work ability in death care workers: The moderating role of vicarious posttraumatic growth

Death care work consists of dealing with traumatic events frequently, if not daily. This type of exposure is considered characteristic of the profession and can lead to significant negative consequences such as secondary traumatic stress. However, sometimes positive changes can occur as a result of experiencing trauma, which is referred to as vicarious posttraumatic growth. The aim of the present study is to investigate the role of vicarious posttraumatic growth (VPTG) in the relationship between secondary traumatic stress (STS) and work ability (WA) in a sample of 231 death care workers in northern Italy. Regression analysis with interaction was performed using PROCESS. The results showed a negative association between STS and WA and a positive association between VPTG and WA. The interaction between STS and VPTG was also statistically significant. The moderating role of VPTG was partially confirmed by the analysis: at low and moderate VPTG levels, the conditional effect was negative and statistically significant, while at high VPTG, STS exposure had no significant and negative effect on WA, as if VPTG had some kind of protective role against STS. These results provide new insights into the role of VPTG in work environments with daily trauma exposure, such as death care.

How midwives' perceptions of work empowerment have changed over time: A Swedish comparative study

OBJECTIVE

The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012.

DESIGN

A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022.

PARTICIPANTS

475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022.

METHODS

Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years.

FINDINGS

Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment.

CONCLUSIONS

Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.

Factors Contributing to Violent Discipline in the Classroom: Findings From a Representative Sample of Primary School Teachers in Tanzania

The need for intervention strategies aiming to reduce teachers' use of violent discipline methods has been expressed repeatedly, especially for countries where this practice is socially and legally accepted. Nevertheless, initial targets for interventions are not clearly identified, as factors contributing to teachers' use of violence are still understudied. In the present study, we examined the interplay between teachers' own experiences of violence, their attitudes, current stress, and their use of violent discipline in a representative sample of 173 Tanzanian primary school teachers (53.7% female, M_age = 38.1 years, SD_age = 10) using structural equation modeling. Our model showed good model fit (χ² [48, n = 173] = 78.058 (p = .004), CFI = .962, TLI = .948, RMSEA = .060 [90% CI [.034, .084], PCLOSE = .233], SRMR = .048). Results indicated direct associations between positive attitudes toward violent discipline (β = .41), stress (β = .23), and teachers' own experiences of violence (β = .21) with teachers' use of violence. Teachers' own experiences of violence were significantly associated with positive attitudes (β = .39), and these significantly mediated the association between teachers' own experiences of violence and their use of violent discipline (β =.23). Our findings underscore the relevance of past experiences, societal norms, and current working conditions in understanding teachers' violence against students. Interventions aiming to reduce teachers' use of violent discipline may focus on stress management, societal norms, personal beliefs on violent discipline, and how teachers' own previous experiences of violence may influence teacher's disciplining behavior.

Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study

Background

Midwives report a challenging work environment globally, with high levels of burnout, insufficient work resources and low job satisfaction. The primary objective of this study was to identify factors in the organisational and psychosocial work environment associated with midwives’ job satisfaction. A secondary objective was to identify differences in how midwives assess the organisational and psychosocial work environment compared to Swedish benchmarks.

Methods

This nation-wide, cross-sectional web survey study analysed midwives’ assessment of their organisational and psychosocial work environment using the COPSOQ III instrument. A multivariable, bi-directional, stepwise linear regression was used to identify association with job satisfaction (N = 1747, 99.6% women). A conventional minimal important score difference (MID ± 5 as a noticeable difference with clinical importance) were used to compare midwives’ results with Swedish benchmarks.

Results

A multivariable regression model with 13 scales explained the variance in job satisfaction (R² = .65). Five scales, possibilities for development, quality of work, role conflict, burnout and recognition, explained most of the variance in midwives’ job satisfaction (R² = .63) and had β values ranging from .23 to .10. Midwives had adverse MID compared to Swedish benchmarks with higher difference in mean values regarding quantitative demands (8.3), work pace (6.0) emotional demand (20.6), role conflicts (7.9) and burnout (8.3). In addition, lower organisational justice (-6.4), self-rated health (-8.8), influence (-13.2) and recognition at work (-5.8). However, variation and meaning of work showed a beneficial difference in mean values with 7.9 and 13.7 respectively.

Conclusions

Midwives reported high levels of meaningfulness in their work, and meaningfulness was associated with job satisfaction. However, midwives also reported adversely high demands and a lack of influence and recognition at work and in addition, high role conflict and burnout compared to Swedish benchmarks. The lack of organisational resources are modifiable factors that can be taken into account when structural changes are made regarding organisation of care, management and resource allocation. Midwives are necessary to a high quality sexual, reproductive and perinatal health care. Future studies are needed to investigate if job satisfaction can be improved through professional recognition and development, and if this can reduce turnover in midwives.

The Experiences of Ghanaian Midwives on the Use of Nonadjustable Delivery Beds: A Qualitative Study

Background

Hospital beds are of great assistance to both clients and caregivers as they give lots of choices to the users. More often, clients have difficulty getting in and out of beds, but the adjustable features of the beds make it possible for them to be comfortable, regardless of their condition. This situation may not be the same if nonadjustable delivery beds (NADBs) are used in conducting deliveries at health care facilities. This study explored the experiences of midwives using NADBs in selected Christian Health Association of Ghana (CHAG) hospitals in the Volta Region of Ghana.

Methods

The study employed an exploratory qualitative research design with purposive sampling. Semistructured interview data were audio recorded. The inclusion criteria were professional midwives with at least 1 year of working skills and the midwives should have conducted deliveries using NADBs during their practice. Data were collected concurrently with data transcription and analyzed using content analysis. Saturation was reached after the 20th interview.

Results

Three themes emerged from the study: NADBs not comfortable to work with, assumption of awkward postures, and the nature of the delivery beds.

Conclusion

The findings of the study show that midwives experience several setbacks in the use of NADBs in conducting deliveries as they sacrifice their health for work.

Work situation and professional role for midwives at a labour ward pre and post implementation of a midwifery model of care - A mixed method study

Purpose: To explore and analyse the experience of work situation and professional role for midwives at a labour ward pre and post the implementation of a midwifery model of care (MiMo).

Methods: A simultaneous mixed method was used. The qualitative core component departed from three focus group interviews (n = 16 midwives). Secondary inductive and deductive content analysis was performed using an unconstrained matrix to make a corresponding comparison of the different time points. The supplemental component was a quantitative survey about the work situation (n = 58).

Results: The qualitative results pre the implementation showed three categories: Balance between Women and Organization, Midwives—Diverse as both Profession and Person, and Strained Work Situation. Post the intervention they transformed to Balance between Midwifery and Organization, Midwives—An Adaptable Profession, Strained Work Situation, and a new category Ability to concretize midwifery was found. There were no significant differences in the measures of work situation in the quantitative analyses.

Conclusions: The synthesized findings based on the qualitative part show that MiMo has a potential to strengthen the professional role and midwifery practice. As such, MiMo has the capability to offer benefits to the labour wards with additional considerations.

Professional courage to create a pathway within midwives' fields of work: a grounded theory study

BACKGROUND

The theory of salutogenesis focuses on resources for health and health-promoting processes. In the context of midwives' work, this is not well described despite the importance for occupational health and the intention to remain in the profession. In order to promote a healthy workplace, it is necessary to consider the facilitating conditions that contribute to a sustainable working life. Therefore, the aim of this study was to explore health-promoting facilitative conditions in the work situation on labour wards according to midwives.

METHODS

A constant comparative analysis was applied to face-to-face interviews with midwives that constituted the empirical material in this classical grounded theory study.

RESULTS

The substantive theory of Professional courage to create a pathway within midwives' fields of work emerged as an explanation of the health-promoting facilitative conditions in midwives' work situation. The theory consists of a four-stage process with prerequisite contextual conditions: visualising midwifery, organisational resources and a reflective and learning environment, that were needed to fulfil the midwives' main concern a Feasibility of working as a midwife. This meant being able to work according to best-known midwifery theory and practice in each situation. Positive consequences of a fulfilled main concern were a professional identity and grounded knowledge that enabled the development of the resistant resource professional courage. The courage made it feasible for midwives to move freely on their pathway within the different fields of work extending between normal and medicalised birth and being autonomous and regulated.

CONCLUSIONS

A professional courage was required to create a pathway within midwives' fields of work, to move freely depending on what actions were needed in a particular work situation. Professional courage could be seen as a resistance resource, enabling midwives to become resilient when dealing with the unpredictable work situation. However, there are vital organisational preconditions that needed to be fulfilled for workplaces to become facilitative, organisational resources, visualising midwifery and a reflective environment. The theory can be used to foster health-promoting and sustainable work situations for midwives, which is possible if the organisational preconditions are met. This could be a key factor in retaining midwives in the profession.

Depression, anxiety and stress in Swedish midwives: A cross-sectional survey

INTRODUCTION

Midwives are exposed to emotional strain, which could affect their overall health. Lack of emotional well-being could be a reason for workforce attrition. The aim of the study was to investigate the prevalence of depressive symptoms, anxiety and stress among Swedish midwives in relation to background variables.

METHODS

A random sample of 1000 midwives were asked to participate and complete a questionnaire. Participants completed the Depression, Anxiety and Stress Scale, Copenhagen Burnout Inventory and Quality of Life inventories together with demographic and work-related data.

RESULTS

In all, 470 midwives responded to the questionnaire (48%). The prevalence of moderate/severe/very severe symptoms of depressive symptoms was 12%, anxiety 8.6%, and stress 7.2%. Midwives aged <40 years and those with <10 years work experience reported higher levels of depressive symptoms, anxiety and stress. The factors most strongly associated with symptoms of depression were personal burnout (AOR=12.26), client burnout (AOR=1.95) and quality of life (AOR=0.26) The factors most strongly associated with symptoms of anxiety were work burnout (AOR=2.53) and personal burnout (AOR=5.61). The factors most strongly associated with stress were personal burnout (AOR=3.90) and work burnout (AOR=3.58) and high quality of life (AOR=0.34).

CONCLUSIONS

Swedish midwives experience symptoms of depression, anxiety and stress. Symptoms of burnout were associated with all aspects of mental health, while high quality of life was protective against these symptoms. These findings are relevant to consider in the work environment for Swedish midwives in order to reduce attrition rates.

Assessment of Stress among Doctors of Dental Medicine

Introduction

The workplace can be a source of stress. One of the most stressful professions is the profession of doctor of dental medicine (dentist). Multiple forms of stressors lead to such occupational stress.

Objective

The research objective was to examine stress levels among dentists in the 25 to 45 year age group.

Materials and Methods

This cross sectional study included 105 doctors of dental medicine throughout Bosnia and Herzegovina, aged between 25 and 45 years. The research was conducted by means of a confidential on-line survey. All participants signed the informed consent, and voluntarily filled out the survey form. The research used the PERCEIVED STRESS SCALE-PSS 10. The statistical analysis used the IBM Statistics SPSS v.21 statistics packages and Microsoft Excel 2010. Descriptive statistics, X² test, and T-test were also used.

Results

Of the total number of respondents, n=105, 66 (63%) of them were female and 39 (37%) male respondents. The mean median value of the score was 23 (Mean = 23.080), as a result of which we can conclude that the respondents in the 25-45 year age population group that participated in this study showed a high level of stress based on the completed questionnaire and the answers received from the respondents.

Conclusion

The estimated level of stress has been shown to be high in both genders, with no statistically significant difference between genders.

Work ability index in Slovenian hospital nurses aged over fifty years

Nurses with reduced work ability are highly susceptible to the deleterious effects of their working environments, and their rates of sick leave, disability, and early retirement are higher than average. The aim of this study was to evaluate work ability in 433 Slovenian hospital nurses aged over fifty years providing secondary care in thirteen hospitals across Slovenia. To do that we used a standardised instrument known as work ability index (WAI). Mean WAI was 36.98±6.46 and median 38. WAI was not associated with age (Spearman's ρ=-0.034, p=0.475). Total WAI score strongly correlated with the 1st item of the WAI questionnaire "current work ability" (ρ=0.726, p<0.001). Higher WAI scores were also associated with academic education, full-time employment, and working in a single (morning) or three shifts. Our WAI findings in nurses over fifty call for systemic changes in the nursing environment to maintain good work ability among nurses until the retirement age and beyond.

Perceived Work Ability Index of Public Service Employees in Relation to Ageing and Gender: A Comparison in Three European Countries

Background

Increasing longevity raised the prospect of a workplace for ageing workers. Previous studies reveal that work ability decreases with age, even among the healthy, and decreased significantly with age among women. The aim of the study is to examine the perception of work ability of public sector employees aged 55 years and older and gender differences in three European countries.

Methods

A prospective longitudinal study design and standardized “Work Ability Index” (WAI) were used. This study analysed the relationship between ageing, gender, and perceived work ability among 1653 employees aged 45.06±10.90 years (562 men and 1091 women) from Spain, Bosnia and Herzegovina and Monte Negro. The research was conducted in 2018.

Results

Older employees had a better WAI than their younger colleagues (P<0.001). The lowest prevalence rate 20% of excellent WAI was between 35 and 44 years of age. The reduction of WAI in Bosnia and Herzegovina was huge 68%, compared with 30% in Monte Negro (more than 2 times) and 14% in Spain (almost 5 times more).

Conclusion

Gender and age was not protector and predictor of excellent or reduced work ability. Work ability did not decrease with age among women and men, public sector employees. Work ability depends of health and safety, promotion and preventive activities at the workplace.

Effect of Stress on the Work Ability of Aging American Workers: Mediating Effects of Health

We examined how stress affects the work ability of an aging workforce, how health mediates this relationship, and how the effects of stress on work ability differ in relation to social status. We analyzed data from the Health and Retirement Survey, namely, 2921 observations in 2010, 2289 observations in 2012, and 2276 observations in 2014. Ongoing chronic stress, social status, health status, and associations with individual work ability were assessed with ordinary least squares regression. Stress was significantly inversely associated with work ability. Health may function as a mediator between individual stress and work ability. The effects of stress and health on work ability decreased as social status increased. To cope with the challenges of aging workforces, future policy-makers should consider job resources and social status.

Psychometric Properties of the French Brief Resilience Scale

Abstract. The Brief Resilience Scale ( BRS) is a reliable and valid assessment of the self-perceived ability to bounce back or recover quickly from stress. The current study translated and validated the French version of the BRS (BRS-F) in a sample of N = 220 midwives. In a confirmatory factor analysis, the unifactorial model fitted acceptably to the data. High levels of Tucker’s φ implied that the component loadings of the BRS-F and of the original BRS are almost equal. The BRS-F demonstrated good levels of reliability and meaningful correlations with mental health symptoms and burnout. The resilience-mental health difficulties link was fully mediated through emotional exhaustion. Thus, the BRS-F is a psychometrically sound assessment of self-perceived resilience, which is now available to researchers and clinicians in French-speaking contexts. The results also suggest that the BRS-F is relevant for use by healthcare professionals who may benefit from interventions aimed at increasing their resilience.

A survey of the genesis of stress and its effect on the academic performance of midwifery students in a college in Ghana

OBJECTIVE

This study assesses the genesis of stress among midwifery students in Ghana and its impact on their academic performance.

DESIGN

A contextual cross-sectional design was used, and data were drawn from a 17-modified-item response from the College Undergraduate Stress Scale (CUSS), a rating of students' academic performance and stress management techniques.

SETTING

The study took place at the Saint Michael's Midwifery Training School located at Pramso, within the Bosomtwe District, Ashanti Region, Ghana.

MEASUREMENTS

The data was analysed using descriptive statistics, factor analysis, χ² test and ordinal logistic regression models.

FINDINGS

Result indicates that academic stressors (schoolwork and less vacation), interpersonal stressors (extracurricular groups, family obligations), intrapersonal stressor (bills/overspending) and environmental stressor (mistakes with expecting mothers) are direct stressors among midwifery students. The study discovered a statistically significant difference in stress management techniques among the study participants (p < 0.05). The multivariate analysis found that respondents' reactions when stressed had a significant effect on their academic performance. However, after adjusting for the stressors, having less vacation had significant effect on respondents' academic performance. Meanwhile, the interaction term significantly strengthens for respondents who had sufficient resting time during vacation.

CONCLUSIONS

Considering the extensive and intense nature of midwifery training per the prescribed curriculum, there is the need for orientation of students on the effect of stress on their academic performance and effective coping mechanisms.

IMPLICATIONS FOR PRACTICE

Regulation and planning of midwifery curricula in the future should incorporate adequate vacation periods to facilitate synthesis of knowledge among students.

Prática simulada: análise de filmes sobre a biomecânica dos estudantes na realização do parto

RESUMO Objetivo: Analisar as posturas dos estudantes do Curso de Mestrado em Enfermagem de Saúde Materna e Obstetrícia; compreender como a intervenção durante o trabalho de parto influencia as posturas; e identificar as estratégias de prevenção das lesões musculoesqueléticas ligadas ao trabalho. Método: Estudo qualitativo e descritivo, que recorreu à gravação e análise fílmica em situação de aprendizagem em Prática Simulada de Alta-Fidelidade. Resultados: Participaram do estudo 13 estudantes. Os resultados evidenciam que o movimento corporal adotado não tem em conta a coordenação do sistema musculoesquelético para manter o equilíbrio, a postura e o alinhamento corporal nas alterações de posição na realização do parto. Conclusão: Os enfermeiros obstetras apresentam elevada prevalência de lesões musculoesqueléticas, e a especificidade da atividade profissional dificulta a avaliação do risco e a sua prevenção. A formação favorece a aquisição de conhecimentos e reflexão de comportamentos. É fundamental investir na formação dos estudantes e dos profissionais nos contextos de trabalho.

Relationships between working conditions and emotional wellbeing in midwives

BACKGROUND

Emotional distress in midwives contributes to high attrition. To safeguard midwives' wellbeing, there is a need to identify the impact of workplace variables.

AIM

To review the existing evidence on the relationships between working conditions and emotional wellbeing in midwives, and construct an analytic framework for understanding these relationships.

METHODS

Systematic search and selection procedures using a range of databases. Results of included studies were synthesised into a thematic literature review of qualitative and quantitative research.

FINDINGS

Various types of poor emotional wellbeing in midwives correlate with a variety of interrelated working conditions, including low staffing/high workload, low support from colleagues, lack of continuity of carer, challenging clinical situations and low clinical autonomy. Staffing levels seem to be able to modify the effects of many other variables, and the impact of challenging clinical situations is affected by several other variables.

DISCUSSION

These workplace variables can be categorised as modifiable and non-modifiable risk indicators.

CONCLUSION

While certain conditions that correlate with midwives' wellbeing are non-modifiable, several crucial variables, such as staffing levels and continuity of carer, are within the control of organisational leadership. Future research and interventions should focus on these modifiable risks. Research design should maximise the chance of establishing causation, while any innovations in this area should anticipate the interrelatedness of these risk factors to avoid unintended negative consequences.

The Relationship Between Job Stress, Personality Traits and the Emotional Intelligence of Midwives Working in Health Centers of Lorestan University of Medical Sciences in 2017

Introduction and Objective: Job stress is one of the major threats to health and it is associated with many diseases and family problems. Midwives experience high job stress due to the management of delivery emergencies. Personality traits and emotional intelligence can be helpful in confronting environmental pressures and selecting the strategy of coping with useful stress. Thus, the current research was conducted to evaluate the relationship between job stress, personality traits and emotional intelligence in midwives of Lorestan health care centers. Methodology: This research was a cross-sectional and correlational study. Midwives working in all cities of the Lorestan province were randomly selected and they completed the job stress, emotional intelligence and personality traits questionnaires. Data were analyzed using SPSS 16 software and a significance level of p <0.05 was considered. Results: The results of the research showed that mean and standard deviation of job stress, emotional intelligence and personality trait midwives were 94.36 ± 12.98, 11.87 ± 14.30, and 135.51 ± 15.73 respectively. The results showed a negative relationship between intelligence and job stress (r= -0/274, p=0.0001) and no significant relationship was found between personality traits and job stress (r = -0.288, p=0.079). Conclusion: A negative correlation was found between emotional intelligence and job stress, so emotional intelligence can reduce midwives' workplace stress.

The Role of Work-Related Factors in the Development of Psychological Distress and Associated Mental Disorders: Differential Views of Human Resource Managers, Occupational Physicians, Primary Care Physicians and Psychotherapists in Germany

Objectives: This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods: Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views. Results: N = 627 participants completed the questionnaires (HRM: n = 172; OP: n = 133; PCP: n = 136; PT: n = 186). The stress dimensions with the highest mean ratings across all four professions were: ‘social relationships in the work place’ (M = 3.55, SD = 0.62) and ‘superiors´ leadership style’ (M = 3.54, SD = 0.64). Mean ratings of perceived relevance of stress dimensions differed most between HRM and the three medical professions. Conclusions: The perceived importance of work-related stress-dimensions seems to be higher in the medical disciplines (OP, PCP, PT) than in the group from the management sector (HRM). However, no fundamental disagreement on the role of work-related stress-dimensions seems to hinder e.g., intensified efforts of cooperation across sectors in tackling the “stress-pandemic” and improving the (mental) health of employees.

Teachers' stress intensifies violent disciplining in Tanzanian secondary schools

Violent forms of discipline in schools continue to be widespread across the globe despite their damaging effects. Since little is known about factors influencing the extent of violence applied by teachers, this study aimed to investigate the influence of teachers' stress, work satisfaction, and personal characteristics on their disciplining style. Using structural equation modeling, associations between violent discipline, burnout symptoms, and job perceptions (pressure and difficulties in class) reported by 222 teachers from 11 secondary schools in Tanzania in 2015 were analyzed. Results indicated a direct association between perceived stress and emotional violent discipline (β=.18, p<.05) as well as physical violent discipline (β=.37, p<.001). Perceived stress also mediated the association between job perceptions and both forms of violent disciplining. The model showed good model fit (χ² [44, n=222]=67.47 (p=.013), CFI=.94, TLI=.91, IFI=.94, RMSEA=.049 [90%-CI=.02-.07, PCLOSE=.50], SRMR=.06). Our findings suggest that teachers' personal perceptions of their work as well as their stress burden play a role in their disciplining styles. Our findings underline the importance of integrating topics, such as stress and coping as well as positive, nonviolent discipline measures into the regular teacher's training and in addition to develop and evaluate school-based preventative interventions for teachers.

Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study

Hospital midwives and neonatal intensive care (NICU) nurses frequently encounter work-related stressors and are therefore vulnerable to developing mental health problems, such as secondary traumatic stress, burnout, anxiety, and depression. However, so far, the exact nature of these work-related stressors (traumatic vs. non-traumatic stressors) has not been investigated. This concurrent triangulation mixed methods cross-sectional study aimed to compare mental health symptoms in hospital midwives and NICU nurses, and to identify and compare work-related traumatic and non-traumatic stressors for both professional groups. 122 midwives and 91 NICU nurses of two Swiss university hospitals completed quantitative measures (Secondary Traumatic Stress Scale, STSS; Hospital Anxiety and Depression Scale, HADS; Maslach Burnout Inventory, MBI) and one qualitative question in an online survey. When controlling for socio-demographic variables, NICU nurses had a higher STSS total score and higher STSS subscales scores and less HADS anxiety subscale scores than hospital midwives. Work-related stressors were classified into five themes: "Working environment," "Nursing/midwifery care," "Dealing with death and dying," "Case management" and "Others." Forty-six (46.3%) percent of these were classified as traumatic work-related stressors. NICU nurses reported more traumatic stressors in their working environment but no other differences between professional groups regarding the total number of work-related traumatic vs. non-traumatic stressors were found. Measures, such as teaching strategies to amend the subjective appraisal of the traumatic stressors or providing time to recover in-between frequently occurring work-related traumatic stressors might not only improve the mental health of professionals but also decrease sick leave and improve the quality of patient care.

The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial

Background

Coronary heart disease (CHD) is the most prevalent type of cardiac disease among adults worldwide, including those in Singapore. Most of its risk factors, such as smoking, physical inactivity and high blood pressure, are preventable. mHealth has improved in the last decade, showing promising results in chronic disease prevention and health promotion worldwide. Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore.

Methods

The smartphone app “Care4Heart” was developed as the main component of the programme. App content was reviewed and validated by a panel of experts, including two cardiologists and two experienced cardiology-trained nurses. A pilot randomised controlled trial was conducted. Eighty working people were recruited and randomised to either the intervention group (n = 40) or the control group (n = 40). The intervention group underwent a 4-week SBCHDP programme, whereas the control group were offered health promotion websites only. The participants’ CHD knowledge, perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Questionnaire-2, Perceived Stress Scale, and Behavioural Risk Factor Surveillance System.

Results

After the SBCHDP programme, participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore (X²  = 6.486, p = 0.039), a better overall CHD knowledge level (t = 3.171, p = 0.002), and better behaviour concerning blood cholesterol control (X² = 4.54, p = 0.033) than participants in the control group.

Conclusion

This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population. Due to the small sample size and short follow-up period, this study was underpowered to detect significant differences between groups. A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0623-y) contains supplementary material, which is available to authorized users.

Translation and psychometric properties of the "ethical conflict in nursing questionnaire: critical care version" in Iran

Introduction

Ethical conflict is one of ICU nurses’ main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the “Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV).” This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses.

Methods

In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis.

Result

Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale.

Conclusions

Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses.

Translation and Psychometric Properties of the Copenhagen Burnout Inventory in Iranian Nurses

Background:

Burnout has its focus on exhaustion and it includes persistent response to long-lasting job-related stressful events. It has a special relevance in health care area in which staff is under constant psychological, emotional, and physical stress. The results of several studies on burnout prevalence among Iranian nurses indicate its high incidence. Therefore, more accurate researches are required for better preventive interventions, and to do so, a reliable validated scale is required. One of the suitable and new tools for the measurement of burnout is Copenhagen Burnout Inventory (CBI). This study aimed to translate and investigate psychometric properties of CBI in Iranian nurses.

Materials and Methods:

In this methodological study, after the translation process, face and content validities via qualitative and quantitative methods was done. Content validation ratio, scale-level content validated index, item-level content validity index were measured. Then, construct validity was determined through factor analysis. Furthermore, internal consistency reliability and stability were assessed. The questionnaire was sent to 450 nurses who were randomly selected via quota sampling.

Results:

Face and content validity were acceptable. After translation and cultural adaptation process, exploratory factor analysis suggested a new model based on four factors and fit indices validated this model via confirmatory factor analysis. Internal consistency and stability of CBI were affirmed for each subscale separately.

Conclusions:

The four-factor Persian version of the CBI proved to enjoy acceptable psychometric properties. It can be applied to evaluate burnout in Iranian nurses or other health care providers.

Professional Quality of Life and Associated Factors Among Ugandan Midwives Working in Mubende and Mityana Rural Districts

OBJECTIVE

To explore the professional quality of life and associated factors among Ugandan midwives working in Mubende and Mityana rural district to recommend interventions to improve professional well-being and outcomes of midwifery care.

BACKGROUND

Professional quality of life of midwives working in rural areas may be influenced by several personal and work setting factors of care professionals often impacting the quality and outcomes of patient care.

METHODS

A cross-sectional study design was used to collect data from 224 midwives working in two rural districts of Uganda.

FINDINGS

The majority of participants were female (80 %), with an associate degree in midwifery (92 %). The mean age and years of experience were 34 ± 6.3 and 4 ± 2.1 years, respectively. The mean scores on the professional quality of life scale showed average compassionate satisfaction (19 ± 4.88), burnout (36.9 ± 6.22) and secondary traumatic stress (22.9 ± 6.69). The midwives' compassion satisfaction was related to psychological well-being (p < 0.01) and job satisfaction (p < 0.01). Conversely, their burnout levels and secondary traumatic stress were associated with education level (p < 0.01), marital status (p < 0.01), involvement in non-midwifery health care activities (p < 0.01), and physical well-being (p < 0.01). CONCLUSION AND IMPLICATION TO PRACTICE: Midwives working in rural areas of resource-poor countries have moderate professional quality of life and tend to experience moderate to high levels of burnout, secondary traumatic stress and compassion satisfaction in their professional work. Therefore, employers need to provide deliberate work based services such as counselling, debriefing, training and social support to enhance midwives professional quality of life and quality of midwifery care and practice.

The Effect of Stress Management on Occupational Stress and Satisfaction among Midwives in Obstetrics and Gynecology Hospital Wards in Iran

Introduction:

Occupational stress is one of the major problems of health care staff, substantially affecting their professional and personal performance. This research has been conducted with the aim of determining the effect of stress management on occupational stress and satisfaction among the Midwives in Obstetrics and Gynecology Hospital wards at Motahari Hospital in Jahrom, Iran 2013-2014.

Methods:

This is a Quasi-experimental study of the pre- and post-clinical trials type. The study population included midwives employed in the Obstetrics and Gynecology Hospital wards selected trough census. The samples were categorized into two groups randomly. The intervention group participated in the short-term training workshop of stress management. The studied samples were measured in terms of occupational stress and satisfaction before, right after, and one month after the workshop. Occupational stress measurement was measured by Toft-Anderson occupational stress questionnaire (1981). Similarly, the occupational satisfaction was measured by JDI checklist developed by Stephen Robins (1994). In order to analyze the information, SPSS 16 together with descriptive statistics tests (frequency, percentile, mean, and standard deviation), independent sample t-tests, iterative measurement and Spearman correlation coefficient were used.

Results:

A total of 70 people (two 35-person groups) of midwives participated in this study. The findings revealed that there was a significant difference between the mean of scores of occupational stress between the two groups before and after the workshop (p=0.001). There was, however, no significant difference between the scores of satisfactions across the two groups.

Discussion:

Training of skills of coping with stress including stress management can be effective in diminishing level of occupational stress. Mitigation of stress without catering for professional, occupational, organizational, and environmental factors would not lead to development of job satisfaction.

Relationship between Work Ability Index and Cognitive Failure among Nurses

INTRODUCTION

Frequent nursing errors are considered as factors that affect the quality of healthcare of patients. Capable nurses who are compatible with work conditions are more focused on their tasks, and this reduces their errors and cognitive failures. Therefore, this study was conducted with the aim of investigating the relationship between work ability index (WAI) and cognitive failures (CFs) as well as some factors that affect them in nurses working in the ICU, CCU, and emergency wards.

METHODS

This descriptive-analytical and cross-sectional study was conducted with 750 nurses at educational hospitals affiliated with the Tehran University of Medical Sciences in 2015. A questionnaire of work ability index and cognitive failures was used to collect data. The data were analyzed using SPSS 20 and the Pearson and Spearman correlation coefficients, chi-squared, ANOVA, and the Kruskal-Wallis tests.

RESULTS

Using the Pearson correlation test, the results of this study showed that there is a significant, inverse relationship between WAI, personal prognosis of work ability, and mental resources with CFs along with all its subscales in nurses (p < 0.05). In addition, there was an inverse and significant relationship between the total score of CFs and the estimated work impairment due to diseases (p < 0.05). There was a significant positive correlation of CFs with age and experience, while WAI was inversely related to age, work experience, and body mass index (BMI) (p < 0.05). WAI and CFs were related significantly to working units (p < 0.05).

CONCLUSION

Considering the results obtained in this study, WAI and the cognitive status of nurses were lower than the specified limit. It is suggested that the work ability of nurses be improved and that their CFs be reduced through various measures, including pre-employment examinations, proper management of work-shift conditions, and using engineering and administrative strategies to ensure the safety of hospitalized patients.

'Midwives Overboard!' Inside their hearts are breaking, their makeup may be flaking but their smile still stays on

PROBLEM

Midwifery practice is emotional and, at times, traumatic work. Cumulative exposure to this, in an unsupportive environment can result in the development of psychological and behavioural symptoms of distress.

BACKGROUND

As there is a clear link between the wellbeing of staff and the quality of patient care, the issue of midwife wellbeing is gathering significant attention. Despite this, it can be rare to find a midwife who will publically admit to how much they are struggling. They soldier on, often in silence.

AIM

This paper aims to present a narrative review of the literature in relation to work-related psychological distress in midwifery populations. Opportunities for change are presented with the intention of generating further conversations within the academic and healthcare communities.

METHODS

A narrative literature review was conducted.

FINDINGS

Internationally, midwives experience various types of work-related psychological distress. These include both organisational and occupational sources of stress.

DISCUSSION

Dysfunctional working cultures and inadequate support are not conducive to safe patient care or the sustained progressive development of the midwifery profession. New research, revised international strategies and new evidence based interventions of support are required to support midwives in psychological distress. This will in turn maximise patient, public and staff safety.

CONCLUSIONS

Ethically, midwives are entitled to a psychologically safe professional journey. This paper offers the principal conclusion that when maternity services invest in the mental health and wellbeing of midwives, they may reap the rewards of improved patient care, improved staff experience and safer maternity services.

Coping strategies used by Iranian nurses to deal with burnout: a qualitative research

Background:

Although numerous studies have reported about coping strategies among health care worker throughout the world, but no research-based data are available on the perception of coping strategy among Clinical nurses in the Islamic Republic of Iran.

Objective:

The aim of the present study was to describe and explore the experiences of Iranian nurses about their coping strategies.

Methods:

In this study we used a qualitative research approach to explore how Iranian nurses perceive and resolve their burnout at work. Twelve nurses were selected by purposive sampling and in-depth semi structured interviews were conducted. All interviews were tape recorded, transcribed verbatim and then analyzed by means of the conventional qualitative content analysis method.

Results:

The 5 main themes that evolved from content analysis included “religious responsibility”, “approximation to God”, “spiritual reward”, “Holiness of the job” and “spiritual journey” emerged as the most important among these.

Conclusions:

The results of this study emphasized that religious or spiritual beliefs give purpose and meaning to nursing interventions, help them tolerate the problems at work, and make nursing care pleasurable. Therefore, although burnout is an important issue in nursing, attending to this dimension of their job is essential and healthcare authorities should pay a special attention to it.

Patients and health care professionals: partners in health care in Croatia?

OBJECTIVES

To explore quality in hospitals from the patients' and health care professionals' perspective in line with Act on the Protection of Patient Rights.

DESIGN

A qualitative study using a focus group design and semi-structured interviews.

METHODS

Three focus groups among health care professionals were conducted with 51 participants: 24 nurses and medical technicians, 15 physicians, 12 residents, followed by additional interviews (20 nurses and medical technicians, 10 physicians, and 2 residents). Twenty patients were interviewed at the time of their discharge from the hospital. Collected data were analysed using thematic analysis.

RESULTS

Patients identified waiting for medical treatments/procedures as the most concerning factor, followed by changes in administration procedures and admission in hospitals. From the physicians' and nurses' perspective, the main topics were inadequate resources to work with and inadequate working environment. Residents emphasized administration and lack of adequate equipment in contrast to other health care professionals. Both patients and health care professionals identified similar organizational and administrative issues impacting on service delivery.

CONCLUSIONS

Health care providers and patients equally recognize the factors that impact upon quality of care. This problem is beyond the health care professionals' possibility to solve, which is the main source of stress and burnout that influence the quality of care. These factors cannot be overcome, by either health care professionals or patient organizations working alone. Greater partnership between health providers and patient associations is needed.

STATEMENT OF CONTRIBUTION

What is already known on this subject? Healthcare providers and patients have the same goal: good quality of care and safety. Croatia has undergone significant socio-economic and political changes, which have affected the organization of the health care system. The patient experience is positively associated with clinical effectiveness and patient safety. What does this study add? From the perspective of patients and health professionals the main concern regarding quality of care is the organization of work in hospitals. Croatian patients and health professionals show considerable agreement with regard to the administrative problems in hospitals. Solutions that include only efforts on the part of the health care worker will fail.

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.