Stress amongst district nurses: a preliminary investigation

Study on the psychological health status and influencing factors of operating room nursing staff

To comprehensively analyze the psychological health status of operating room nurses and identify influencing factors. The research compares psychological health differences based on nurses' years of experience, specifically examining depression and anxiety scores. A detailed assessment was conducted, focusing on nurses with varying experience levels. Findings revealed higher depression scores among mid to senior-level nurses, while junior-level nurses exhibited elevated anxiety scores. Additionally, overall dissatisfaction with physical health and various subhealth symptoms were reported. Multifactorial analysis identified working hours, disaster relief experience, and perceived occupational benefits as primary influencers. Through comparative analysis, it was found that the average score of self-rating depression scale and self-rating anxiety scale was 53.8 ± 12.2 points and 47.6 ± 10.5 points respectively. The depression score of middle and senior nurses was significantly higher than that of junior nurses (P < .05). The anxiety score of primary nurses was significantly higher than that of middle and senior nurses (P < .05). The results indicate that the duration of work, previous experience in disaster relief, and nurses' perception of occupational benefits were the main factors influencing the psychological health status of operating room nurses (P < .05). Healthcare institutions are recommended to implement targeted interventions based on nurses' experience levels, addressing specific psychological health needs. Future research should delve into specific subgroups, conduct long-term tracking, expand the scope of influencing factors, assess the effectiveness of intervention measures, and explore cross-cultural aspects.

Impact of thriving at work on eustress and distress: career growth as mediator

Purpose

Thriving at work can affect eustress and distress differently, so the main purpose of this study is to determine the impact of thriving at work on stress and to extend the existing literature on stress by examining the mediating mechanism of career growth, which is one of the functions of human resource development, in the relationship between thriving at work and stress. Person environment fit theory is used to explain the framework.

Design/methodology/approach

Data were collected from 179 employees of the hospitality sector of Pakistan to assess the impact of thriving at work on eustress and distress through the mediation of career growth. Structural equation modeling was used to test the hypotheses.

Findings

Results revealed thriving at work is positively related to eustress whereas it is negatively related to distress, and there is a positive association between thriving and career growth. Furthermore, career growth appeared as an effective explanatory mechanism for relationships between thriving at work and stress. Implications for managers are also discussed.

Originality/value

This study encompasses both positive and negative stressors. There are lots of studies available that examine thriving at work and stress, but the present study aims to examine the impact of thriving on both aspects of stress in the presence of career growth as the mediator in the hospitality sector of Pakistan. It also opens new avenues for research on P-E fit theory to gain benefit from the eustress of employees.

The home care work environment's relationships with work engagement and burnout: A cross-sectional multi-centre study in Switzerland

This study aimed to investigate the levels of burnout and work engagement among home care workers in Switzerland and to test their association with job demands and job resources. We conducted a multi-centre, cross-sectional survey in the German-speaking part of Switzerland with a convenience sample of seven home care agencies. Data were collected between September 2017 and January 2018. We assessed burnout with the Maslach Burnout Inventory (MBI) and work engagement with the Utrecht Work Engagement Scale (UWES) as well as job demands (overtime, work-family conflicts, experienced aggression and work stressors) and job resources (predictability, staffing, teamwork, leadership, collaboration, social support, sense of community, feedback). To investigate the levels of burnout and work engagement, we applied descriptive statistics. Based on Bakker and colleagues' Job Demands-Resources model, we used a path analysis to test the associations of job demands and job resources with burnout and work engagement. We analysed data from 448 home care workers (response rate 61.8%, mean age 44 years (SD 13.2), 96% female). The frequency of burnout in our sample was low, while that of work engagement was high. Job demands correlated positively with emotional exhaustion (β = .54, p < .001) and negatively with work engagement (β = -.25, p < .001). Job resources correlated negatively with emotional exhaustion (β = -.28, p < .001) and positively with work engagement (β = .41, p < .001). Work-family conflicts and work stressors correlated strongest with emotional exhaustion, whereas social support and feedback were found to correlate strongest with work engagement. Improvements to the home care work environment might enhance work engagement and reduce burnout. Corrective interventions could focus on reducing specific aspects of job demands, such as work-family conflicts and work stressors, as well as on increasing aspects of job resources, especially social support and feedback.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Professional voices on risk and accidents in home care – a Swedish survey study

Purpose

The purpose of this study is to find out what knowledge and experience of occupational therapists, personal assistants and public health nurses/nurses in Sweden can contribute concerning the vulnerability of residents to injury in different residential care-settings.

Design/methodology/approach

This study is based on an online survey. A total of 832 individuals responded to the survey. The data were analyzed from a mixed-method approach, using descriptive statistics, correlations and textual-analysis.

Findings

More than one in four representatives of these professions had witnessed accidents. The results show that bedrooms and bathrooms are the rooms in which accidents are most likely to occur in homes.

Research limitations/implications

One limitation of the study is that the impact of educational initiatives on the different professions was not investigated, so it is not possible to ascertain what effect this may have had on risk identification and accident prevention measures in residential care-settings.

Originality/value

To the best of the authors’ knowledge, no prior study of these issues has been conducted. This study is deemed to have significant social benefit because of the steadily increasing need for care in residential settings. No other study has addressed the importance of the physical environment in this context. Collaborations involving researchers from various disciplines, professional organizations and public and private sector employers involved in personal assistance have contributed specific knowledge.

A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses

BACKGROUND

Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.

AIM

To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.

METHOD

Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout.

PARTICIPANTS

A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.

RESULTS

Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout.

CONCLUSION

High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.

ASSESSING FACTORS THAT AFFECT COPING STRATEGIES AMONG NURSING PERSONNEL

Introduction:

The nursing profession is characterized as one of the most stressful professions. A significant number of international surveys prove that nurses experience anxiety that often is accompanied by intense symptoms that negatively affect their work performance and their psychological mood.

Aim:

To evaluate the ways of coping in stress adopted by the nursing staff and their relationship with sociodemographic and job characteristics.

Methodology:

A cross-sectional, quantitative study was conducted in seven hospitals of Peloponnese Region, Greece. The study took place between April 2013-June 2013 and 395 nurses completed the Ways of Coping questionnaire. Socio-demographic, educational and job characteristics of nurses were, also, recorded.

Results:

Strategies focused on the problem were adopted to a greater extent more by postgraduate nurses, head nurses, and nurses with greater working experience. Intensive Care Unit nurses mainly adopted the strategy of denial while strategies focused on emotions were mostly adopted by females. Age and marital status did not affect significantly the choice of coping strategies.

Conclusions:

According to our findings several demographic factors that affect coping in stressful situations can be investigated and such an investigation could offer useful research findings for consideration.

A longitudinal study of aspects of a hospital's family-centred nursing: changing practice through data translation

AIMS

To examine how results and data from multiple Family Centred Nursing Index surveys help the development of family-centred nursing at organizational and ward levels.

DESIGN

A critical analysis of survey data.

BACKGROUND

The Family Centred Nursing Index provides a valid and reliable assessment of aspects of nursing, through a comprehensive survey of traditional indicators of practice development and a broader range of aspects of practice.

METHODS

A survey with 113 questions, each to be answered on 7-point Likert scale conducted six times in the last 7 years. Surveys have been in 2006, 2008, 2009, 2010, 2011/2012 and 2012/2013. All nurses employed by the organization can participate.

RESULTS

These are reported as means across 19 constructs linked to five key domains and their significance is examined by year and (in the clinical settings) and compared against the organizational (whole population) averages. Ongoing survey and analysis of nurses' views of their work is providing a valuable source of developmental data. The results show unexpected associations between constructs e.g. - a high level of work stress does not correlate with a lower level of job satisfaction (and vice versa). A clear historical picture of many elements of developing family-centred care is emerging at both the organizational and individual-ward levels.

CONCLUSION

This study provides insights into aspects of organizational and wards working environment for nurses and how these aspects of nurses' work interact in unexpected ways. It is appropriate for providing information to organizations and ward teams in relation to their development towards family-centred cultures.

Relational regulation theory and the role of social support and organisational fairness for nurses in a general acute context

AIMS AND OBJECTIVES

To present a novel approach to nurse stress by exploring the demand-control-support model with organisational justice through the lens of relational regulation theory.

BACKGROUND

Nursing is often stressful due to high demands and dissatisfaction with pay, which impacts the mental well-being and productivity of nurses.

DESIGN

A cross-sectional design.

METHODS

A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-sized general acute hospital in Australia. A total of 190 nurses and midwives returned completed questionnaires for the analyses.

RESULTS

The multiple regression analyses demonstrated that the model applies to the prototypical context of a general acute hospital and that job control, supervisor support and outside work support improve the job satisfaction and mental health of nurses.

CONCLUSIONS

Most importantly, supervisor support was found to buffer the impact of excessive work demands. Fairness of procedures, distribution of resources and the quality and consistency of information are also beneficial. Relational regulation theory is applied to these findings as a novel way to conceptualise the mechanisms of support and fairness in nursing.

RELEVANCE TO CLINICAL PRACTICE

The importance of nurses' well-being and job satisfaction is a priority for improving clinical outcomes. Practically, this means nurse managers should be encouraging nurses in the pursuit of diverse relational activities both at work and outside work.

Behavior of personality type toward stress and job performance: a study of healthcare professionals

Background:

The present paper has examined the sources of stress among the healthcare professionals and the difference between responses of personality type A and type B healthcare professionals toward stressful situations. Further, the difference in the performance of both the personality types has been studied. The relationship between stress and performance among the healthcare professionals in general and with respect to personality type A and type B healthcare professionals in particular has also been investigated.

Methods:

A total of 160 healthcare professionals of Post Graduate Institute (PGI), Chandigarh, were subjects of this study.

Results:

Identification with patients, deterioration and complication in the patient condition, and job criticism emerged to be the sources of stress. Significant difference between personality type A and personality type B professionals’ response pertaining to identification with the patients only has been reported. However, type A individuals showed slightly higher inclination as compared to type B individuals on majority of stressful situations. It was further noted that type A individuals had scored higher on almost all the performance indicators as compared to personality type B individuals. The mean difference between the personality types was found to be significant for two performance dimensions, i.e., relationship with colleagues, and teaching and training.

Conclusions:

The stressful situation relationship with patients was found to have significantly negative impact on the performance factors such as good clinical care and rapport with patients. Daily work was also found to be negatively related to good medical practice.

Coping with interpersonal stress and psychological distress at work: comparison of hospital nursing staff and salespeople

Hospital nurses frequently experience relationships with patients as stressors in the workplace. Nurses’ coping behavior is one potential buffering factor that can reduce the effects of job stress on their psychological functioning and well-being. In this study, the association between nurses’ strategies for coping with interpersonal stress from patients and their psychological distress was examined. Participants included 204 hospital nurses and 142 salespeople, who were used as a comparison group. Participants completed measures of coping with interpersonal stress and psychological distress. Hospital nurses reported more psychological distress than did salespeople. Moreover, distancing coping was correlated with high psychological distress in both nurses and salespeople, and reassessing coping was correlated with low psychological distress in nurses. For nurses only, constructive coping appeared to be an effective strategy for reducing psychological distress. It is important for nurses to understand the role of constructive coping in nurse–patient communication and interaction.

Patient knowledge in inflammatory bowel disease: the Crohn's and Colitis Knowledge Score

In the UK, key professional organizations have joined to provide inflammatory bowel disease (IBD) standards to be delivered by the NHS, highlighting the importance of patient education and support. The Crohn's and Colitis Knowledge Score (CCKNOW) is a validated multiple-choice questionnaire on the subject of IBD that is able to objectively quantify the level of patient knowledge. The aim of this study was to summarize the findings of the CCKNOW, in particular, the current level of patient knowledge and the implications clinically. Literature search was conducted using Medline, Google Scholar and the Cochrane Library, compiling results of studies using the CCKNOW to date. In the UK, a median score of 10 was achieved by participants with IBD in Leicestershire in 1999. Recent surveys in the Northwest and Pennine Trust achieved median scores of 9 and 7, respectively. Knowledge deficits regarding fertility and pregnancy were found, as seen in 1999. Studies in Canada and Iran achieved median scores of 13 and 4, respectively. Sri Lanka achieved a mean score of 6.86 (range 1-16). Higher CCKNOW scores were associated with the use of adaptive coping strategies. A significant positive link was found between patient knowledge and anxiety levels. There was no significant difference in CCKNOW scores between patients with the complication of colorectal cancer versus control populations. In the UK, patient knowledge of IBD may be no better than in 1999. The subjects of fertility and implications for pregnancy are particular areas of deficit. Further knowledge shortfalls may exist in the developing countries. Evidence suggests that improving knowledge may empower patients to use more adaptive coping strategies but may not be effective in reducing anxiety or the risk complications such as colorectal cancer.

Factors influencing job satisfaction among registered nurses: a questionnaire survey in Mashhad, Iran

BACKGROUND

Job satisfaction is a critical factor in health care. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care.

OBJECTIVE

To determine the level of nurses' job satisfaction and its associated factors.

METHOD

A stratified random sample of 421 registered nurses working at a large hospital in Mashhad, Iran was surveyed.

RESULT

The results showed that autonomy, task requirement and work interaction had scores higher than their respective median on the subscales. There were significant differences between demographic characteristics and the autonomy, task requirement, work interaction, salary, work condition, professional development, supportive nursing management, decision making, professional status subscales and mean total job satisfaction. In univariate analysis, young age, being female and being married were significantly associated with a higher level of job satisfaction. The adjusted R(2) for this model was 0.14, indicating that the model explained 14% of the variability. The regression model was highly significant, F (4298) = 13.194, P < 0.001.

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

The authors emphasise that the human resources policies and incentives need to be re-visited. Efforts undertaken to improve working conditions, supportive nursing management, improved professional status, professional development and increased salaries are some of the ways for nurse managers to improve job satisfaction.

Job satisfaction among public health nurses: a national survey

BACKGROUND

Despite increasing interest in nurses' job satisfaction relatively few studies have investigated job satisfaction among public health nurses.

AIM

To establish current level of job satisfaction among public health nurses and identify the main contributing variables/factors to job satisfaction among this population.

DESIGN

Quantitative descriptive design. A simple random sample of 1000 public health nurses was conducted yielding a response rate of 35.1% (n = 351). Data was collected using the Index of Work Satisfaction Questionnaire. Descriptive and inferential statistics were deployed.

RESULTS

Low levels of job satisfaction among public health nurses emerged. Professional status, interaction and autonomy contributed most to job satisfaction while pay and task-related activities contributed least. Age and tenure were the only biographic factors that correlated significantly with job satisfaction.

CONCLUSION

Public health nurse managers/leaders need to find creative ways of improving the factors that contribute to job satisfaction and address robustly those factors that result in low job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical issue for public health nurse managers is to determine how job satisfaction can be improved. Greater collaboration and consultation between managers and public health nurses can be regarded as a useful way to begin this process, especially if contemporary nursing is to embrace a responsive approach within the profession.

‘Catching up’: The significance of occupational communities for the delivery of high quality home care by community nurses

This article examines the importance of some informal work practices among community nurses during a period of significant organizational change. Ethnographic fieldwork in two purposively selected adult community nursing services in England comprised 79 hours of observation of routine practice, 21 interviews with staff and 23 interviews with patients. We identified the informal work practice of ‘catching up’, informal work conversations between immediate colleagues, as an important but often invisible aspect of satisfying work relationships and of the relational care of patients. Drawing on anthropological literatures on ‘communities of practice’ the article examines two central issues concerning the practices of ‘catching up’: (1) how informal learning processes shape community nursing work; (2) how this informal learning is shaped both in relation to the ideals of community nursing work and the wider political and organizational contexts of community nursing practice. Our findings highlight the distinctive value of informal workplace ‘catch ups’ for nurses to manage the inherent challenges of good home care for patients and to develop a shared ethic of care and professional identity. Our findings also indicate the decline of ‘catching up’ between nurses along with diminishing time and opportunity for staff to care holistically for patients in present service climates.

Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia: a cross-sectional study

BACKGROUND

Quality of work life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. QWL has been found to influence the commitment and productivity of employees in health care organizations, as well as in other industries. However, reliable information on the QWL of primary health care (PHC) nurses is limited. The purpose of this study was to assess the QWL among PHC nurses in the Jazan region, Saudi Arabia.

METHODS

A descriptive research design, namely a cross-sectional survey, was used in this study. Data were collected using Brooks' survey of quality of nursing work life and demographic questions. A convenience sample was recruited from 134 PHC centres in Jazan, Saudi Arabia. The Jazan region is located in the southern part of Saudi Arabia. A response rate of 91% (n = 532/585) was achieved (effective response rate = 87%, n = 508). Data analysis consisted of descriptive statistics, t-test and one way-analysis of variance. Total scores and subscores for QWL items and item summary statistics were computed and reported using SPSS version 17 for Windows.

RESULTS

Findings suggested that the respondents were dissatisfied with their work life. The major influencing factors were unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs, inadequacy of vacations time for nurses and their families, poor staffing, management and supervision practices, lack of professional development opportunities, and an inappropriate working environment in terms of the level of security, patient care supplies and equipment, and recreation facilities (break-area). Other essential factors include the community's view of nursing and an inadequate salary. More positively, the majority of nurses were satisfied with their co-workers, satisfied to be nurses and had a sense of belonging in their workplaces. Significant differences were found according to gender, age, marital status, dependent children, dependent adults, nationality, nursing tenure, organizational tenure, positional tenure, and payment per month. No significant differences were found according to education level of PHC nurses and location of PHC.

CONCLUSIONS

These findings can be used by PHC managers and policy makers for developing and appropriately implementing successful plans to improve the QWL. This will help to enhance the home and work environments, improve individual and organization performance and increase the commitment of nurses.

Stressor Scale for Clinical Research Coordinators: development and psychometric testing

AIM

This article is a report of the development and psychometric testing of the Stressor Scale for Clinical Research Coordinators.

BACKGROUND

Job stress is viewed as a situation where working conditions interact with individual worker characteristics and result in disruption of psychological or physiological homeostasis. Clinical research coordinators, also known as research nurses, are professionals who play a central role in clinical trials. They face various problems associated with their responsibilities; however, few studies have reported on their stress. To manage their stress, it is necessary to identify the sources of stress (i.e. stressors).

METHOD

The 56-item preliminary instrument was developed based on literature review and expert discussions. A total of 589 clinical research coordinators in 186 hospitals in Japan were surveyed in 2011. Statistical analyses on construct and concurrent validity, internal consistency, and test-retest reliability were performed.

RESULTS

A six-factor solution with 23 items was selected using exploratory factor analysis: 'quantitative workload', 'conflict with investigators', 'ambiguity of work', 'conflict with other clinical research coordinators and with supervisors', 'demands from an affiliate other than the hospital', and 'difficulty in caring for trial participants'. Confirmatory factor analysis affirmed construct validity, with a demonstrated acceptable fit between the factor structure and the observed data. All factors had significant correlations with burnout and psychological distress, which indicated acceptable concurrent validity. Cronbach's alpha coefficients ranged from 0·73-0·82. Intra-class correlation coefficients indicated almost satisfactory test- retest reliability.

CONCLUSION

Our new instrument has acceptable validity and reliability for evaluating job stressors for clinical research coordinators.

Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

Job satisfaction among intensive care nurses from the People's Republic of China

BACKGROUND

Prior research has suggested that job satisfaction is a major concern for both nurses and healthcare administrators. A variety of workplace stressors, coping strategies and demographic characteristics have been found to contribute both positively and negatively to job satisfaction. However, most of this research has been conducted in Western culture countries, leaving one to wonder if the findings are relevant in China, particularly in regard to intensive care nurses.

AIM

Therefore, the purpose of this descriptive study was to determine, in intensive care nurses from the People's Republic of China, which combination of workplace stressors, coping strategies and demographic characteristics was the best predictor of job satisfaction.

METHODS

To address these purposes, four self-report questionnaires were administered to a convenience sample of 102 intensive care nurses from four teaching hospitals located in two cities in central China.

RESULTS

The best predictors of job satisfaction were workload, years of experience in nursing, uncertainty about patients' treatment, behavioural disengagement and positive reframing.

CONCLUSIONS

The findings provide information about what factors need to be considered and addressed in the workplace to facilitate job satisfaction among Chinese intensive care nurses.

Nursing the dying within a generalist caseload: a focus group study of district nurses

BACKGROUND

Community nurses (members of UK District Nursing teams) have a key role in the provision of palliative care in the community in the UK. However, their views about delivering palliative care within their generalist workload have not been assessed.

OBJECTIVES

To explore community nurses' perceptions of their palliative care role, and their provision of such care within the context of their wider generalist workload.

DESIGN

Focus group study.

SETTING

Four Primary Care Trusts in London, UK.

PARTICIPANTS

A purposive sample of 51 community nurses.

METHODS

Nine focus groups (four to seven participants in each) were conducted between 2003 and 2004. Data were analysed using the framework approach.

RESULTS

We identified five broad themes. Community nurses felt they had a central role in the provision of palliative care to patients at home. Many felt this role was not recognised by other health care professionals and managers. Palliative care was identified as unpredictable and time-consuming within a pressurized context characterised by staff shortages and consequent lack of time. Whilst rewarding, palliative care took its toll on nurses' emotions, compounded by a perceived lack of formal support. Finally, undertaking palliative within a generalist workload created additional pressures for community nurses.

CONCLUSIONS

The integration of palliative care into routine generalist caseloads generated workload stresses in time and emotion. Community nurses felt their palliative care role and its impact on workload was not adequately acknowledged. Palliative care specific support mechanisms and ways of working may be necessary to meet patients' and professionals' expectations of effective, compassionate care at the end of life.

The nature and impact of urinary incontinence experienced by patients receiving community nursing services: A cross-sectional cohort study

BACKGROUND

Nurses have played a pivotal role in the delivery of continence services yet little is known about the nature or impact of urinary symptoms experienced by patients in receipt of such care.

AIM

To define the nature and impact of urinary symptoms experienced by patients in receipt of community nursing services.

METHOD

The Leicestershire Urinary Symptoms Questionnaire was administered to 1078 patients with incontinence identified from 176 community nurses' caseloads in 157 general practices in England. Information included type and severity of urinary symptoms, impact on quality of life, help with coping, use of continence products and health service resources.

RESULTS

Nine hundred and ninety nine (92.7%) patients (median age 79.0 years) returned completed questionnaires. Most patients had incontinence between 1 and 5 years duration, women were more likely than men to have had long standing ( > 5 years) symptoms and more than half the sample reported severe leakage. Women were more likely than men to report symptoms of stress incontinence (71.7% and 46.8%, respectively, p < 0.001) and urge incontinence UI (86.3% vs. 74.8%, respectively, p < 0.01). Half of the men and most women also experienced leakage as a result of difficulty getting to, on or off, a toilet/commode. Men were more likely than women to report getting up three or more times a night to pass urine (53.6% vs. 37.0%, respectively, p < 0.05). Most patients reported that their symptoms had a significant impact on many aspects of quality of life, and 45.7% would be very dissatisfied to continue "the way they are now". Professional help appeared principally one of containment.

CONCLUSION

Many people with incontinence receiving community nursing services experience two or more urinary symptoms which, in the majority, have a significant impact on quality of life. Many older patients were not satisfied to "put up" with their urinary symptoms. Current service provision appears to be failing those who are most in need of such care.

Nurses and palliation in the community: the current discourse

A core component of community nursing practice in Australia is the provision of palliative care, however this area of practice has been minimally researched. We, therefore, undertook a broader review of the contemporary literature in community nursing; palliative nursing; and community nursing palliative care. Literature was searched electronically in OVID, CINAHL and nursing databases and manually in relevant journals. Findings revealed community and palliative care nursing to be both complex and challenging. Community and palliative nurses ideals for care are compromised by competing practice demands. Changing health systems and philosophical views, limited resources and the perceived 'visibility/invisibility' polarity are identified as major job stressors. Therapeutic use of 'self' and interpersonal communication are recognized as contributing to job satisfaction. Community nurses providing palliative care is as an under researched area yet it is a role that arguably requires critical understanding and recognition. Further research is needed into the relationship between emotional well-being and professional satisfaction for community and palliative care nurses providing palliation.

The psychological effects of organizational restructuring on nurses

AIM

This paper reports a comparison of nurses affected by the restructuring associated with healthcare organization mergers (1998-2000) in the United Kingdom and those of non-affected nurses in the UK.

BACKGROUND

Restructuring, a feature of healthcare organizations for decades, has been associated internationally with negative outcomes for nurses. Despite this, no model to evaluate management of change factors and psychological stress processes has been operationalized and tested.

METHOD

A sample of 351 Registered Nurses was recruited from southern England. Participants either worked in organizations that were within 6 months of merging or were not affected by mergers. On two occasions, 6 months apart, all were sent a questionnaire that had been formulated for the study. Questions related to the parts of the model being tested: restructuring initiatives (i.e. stressors) information and participation, coping action, and coping effectiveness (i.e. outcomes). The data were collected between 1998 and 2000.

FINDINGS

Nurses affected by mergers reported statistically significantly higher restructuring initiatives before and after an event than non-affected nurses. Moreover, up to 12 months after an event some affected nurses reported lower information and participation, and lower coping effectiveness (i.e. higher job insecurity, job stress, job pressure, lower job satisfaction, physical, psychological, and environmental quality of life) than non-affected nurses, which was consistent with the model's proposals. However, there was no difference between affected and non-affected nurses' coping action.

CONCLUSION

The psychological effects of restructuring are linked with perceptions of low information and participation, and with negative outcomes for nurses. Managers, therefore, need to communicate information and encourage staff to participate in decisions about restructuring events.

Developing a managed clinical network in palliative care: a realistic evaluation

BACKGROUND

The attainment of evidence-based practice is at the fore of the international practice development agenda. It is therefore imperative that robust evaluation methodologies are available to scrutinise new approaches to service development.

OBJECTIVES

This paper reflects on the merits and challenges of realistic evaluation design in the establishment of a new managed clinical network (MCN) approach to implementing a guideline concerned with the care of individuals with cancer-related pain.

DESIGN AND METHODS

There were three evaluation points scrutinising three versions of the MCN approach to care. At each stage, steps were taken to identify the context, mechanisms and outcomes associated with the version of the model under scrutiny. Findings from patient-centred case studies fed into realistic evaluation interviews with the management group.

SETTING

A rural primary care setting in Scotland.

PARTICIPANTS

Three older men, their families, and the doctors and nurses providing direct care participated, along with 13 members of the network management group.

RESULTS

The investigation highlighted the level of practitioner effort required to introduce the MCN approach to care. Progress was much slower than anticipated, at times frustrated by inexperience in change management and unfamiliarity with leading practice development projects and supporting practitioner learning. Issues to do with the age appropriateness of the evidence base in relation to the care of frail older people were also apparent. The professional group that experienced most role change were district nurses and community pharmacists.

CONCLUSION

The collaborative approach nurtured by the realistic evaluation framework was found particularly helpful and there was consensus that the evaluation had become integral to the intervention itself. There were a number of methodological challenges and a need to limit the depth of 'realistic unravelling'. However, as a formative approach, in the messy world of interdisciplinary practice development, realistic evaluation proved a worthy design.

Changes in community nursing in Australia: 1995-2000

AIM

This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work.

BACKGROUND

There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care.

METHODS

Four sources of data were used: community health client administrative data 1995-2000; occasions of service data 1995-2000; staffing numbers 1998-2001; and interviews with 14 community nurses in late 2001.

RESULTS

Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes.

CONCLUSION

Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.

Palliative care for patients with cancer: district nurses' experiences

AIM

This paper reports a study exploring district nurses' experiences of providing palliative care for patients with cancer and their families.

BACKGROUND

There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experiences in palliative care.

METHOD

A Husserlian phenomenological approach was adopted with a purposive sample of 25 female district nurses. Data were collected using unstructured, tape-recorded interviews and analysed using Colaizzi's seven stages of data analysis.

FINDINGS

Four themes were identified: the communication web; the family as an element of care; challenges for the district nurse in symptom management and the personal cost of caring.

CONCLUSIONS

District nurses' experiences of providing palliative care to family units was challenging but rewarding. The emotive nature of the experience cannot be under-estimated, as many district nurses were touched by the varying situations. Whilst acknowledging the need to maintain an integrated approach to care, district nurses should be identified as the key workers in the complex situation of palliative care.

Predictors of life satisfaction of Korean nurses

AIM

This paper reports a study to identify the levels of work satisfaction, burnout and life satisfaction among Korean hospital nurses and the relative importance of negative and positive work outcomes (burnout and work satisfaction) in explaining the variance of life satisfaction of nurses.

BACKGROUND

Previous research has demonstrated that work outcomes such as job satisfaction and burnout can affect overall life satisfaction. It is not yet known, however, whether positive and negative aspects of work outcomes exert equally strong or varying degrees of effect, nor whether the relationships demonstrated primarily in Western cultures also are present in other cultures. Given the widespread shortage of nurses, it is important to identify areas for organizational interventions that have the greatest potential for improving both recruitment and retention of nurses.

METHODS

A cross-sectional correlational design was used. A survey was undertaken with 194 nurses from general hospitals of 300 beds or more in southern Korea between May 1999 and March 2000. Paper and pencil self-rating questionnaires were used to gather information. Data were analysed using descriptive statistics, Pearson correlations and multiple regressions.

RESULTS

Korean nurses reported moderate levels of life satisfaction, with low levels of work satisfaction and high levels of burnout. Burnout explained more variance in life satisfaction than work satisfaction. Those who experienced higher personal accomplishment and lower emotional exhaustion and who were satisfied with their professional status and did not work at night reported higher life satisfaction.

CONCLUSIONS

This study highlights the relative importance of negative work outcomes on nurses' overall well-being. Strategies to reduce emotional exhaustion, enhance nurses' personal accomplishment and satisfaction with professional status, and accommodate shift preferences for work scheduling were suggested. Replicating this study with nurses from other geographic areas using random selection will be needed to increase the generalizability of the findings.

Stress and coping among cardiovascular nurses: a survey in Brazil

Cardiovascular nurses are frequently involved in critical patient care, providing support to patients and their families. The goals of this study were to survey a representative sample of cardiovascular nurses, describe ways of coping, and identify sources of stress in the hospital setting. A descriptive and correlational survey design was used. A self-completed questionnaire was distributed to 76 nurses from a cardiovascular hospital in São Paulo City, Brazil. The measures were the Nursing Stress Evaluation Questionnaire (NSEQ) by Bianchi and Ways of Coping Questionnaire (WCOQ) by Folkman and Lazarus. A high response rate of 76.3% was achieved. The results identified work conditions as the major source of stress for nurses and use of positive reappraisal, self-controlling skills, and social support to cope with job stress. Nurses are using coping strategies based on personal resources but the use of organizational strategies is encouraged to improve life quality. Mental health nurses could play an essential role in preventive stress management programs for hospital nurses.

Families in home care--a resource or a burden? District nurses' beliefs

BACKGROUND

Caring for families in home care is a growing part of Swedish district nurses' professional work. District nurses' facilitative and constraining beliefs about families guide the extent to which families are acknowledged and engaged in the care.

AIMS AND OBJECTIVES

The aim of the study was to explore district nurses' beliefs about families in home care.

DESIGN

Explorative, descriptive.

METHODS

Five district nurses participated in focus group interviews on three separate occasions. Each interview lasted approximately 90 minutes, was audio taped and transcribed verbatim. A thematic content analysis was used for analyses of the data.

RESULTS

The result revealed two underpinning beliefs held by the district nurses towards families in home care: families are a resource and Families are a burden. Families could be a resource for the patient, for the other family members as well as for the district nurses themselves. Families could be a resource for the patient both practically and emotionally by e.g. being present and listening. Being open in communication with other family members and district nurses was also considered as a resource. The district nurses considered families as a burden when they were experienced as demanding in various ways, for example, when family members did not act in a way that pleased the district nurses or when family members showed their suffering.

CONCLUSIONS

This study highlight some facilitating and constraining beliefs held by district nurses: families can be both a resource and a burden.

RELEVANCE TO CLINICAL PRACTICE

It is important that district nurses are aware of what beliefs they hold as their beliefs guide their actions towards the families.

Value congruence and job satisfaction among nurses: a human relations perspective

The relationship between job satisfaction and value congruence within four organizational value areas was studied among nurses at surgery wards. Congruence between perceived and desired human relations values and social climate independently determined attitudes toward the nurse's ward. Social climate was operationalized as the habit of chatting with colleagues, and was inversely related to time pressure. Ward attitudes predicted job satisfaction, although structural equation modeling suggested that human relations value congruence also predicted job satisfaction directly, in addition to its effect through ward attitudes. Human relations value congruence thus appeared as an important ingredient of person-organization fit in nursing.

Environmental elements affecting the decision-making process in nursing practice

BACKGROUND

In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision-maker and the task itself, the setting where the decision-making process takes place are of decisive importance to the quality of the decision-making outcome.

AIM

The aim of this study was to explore environmental elements related to the decision-making process in nursing practice.

METHODS

Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision-making process of nurses.

CONCLUSIONS

The most striking theme, environmental elements, included the sub-themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision-making in practice.

RELEVANCE TO CLINICAL PRACTICE

Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision-making outcome. Therefore, it is of greatest importance that nurses learn to use decision-making strategies to guarantee patient care security and patient care quality.

Job stress, coping and health perceptions of Hong Kong primary care nurses

Few empirical studies have investigated job stress, coping and health perceptions of nurses working in primary care settings. One thousand self-report questionnaires, which consisted of the modified Nursing Stress Scale, Coping with Work Stress Checklist and Health Perceptions Questionnaire, were distributed randomly to a group of Hong Kong nurses working in primary care settings, to examine issues related to job stress. Three hundred and sixty-two nurses responded. Findings indicated that nurses in these settings experienced low-to-moderate frequency of stress, adopted direct coping strategies, and perceived themselves as rather healthy. There were also statistically significant links between job stress, coping and perceived health status. The findings of this study suggest that job stress, coping and health perception of nurses working in primary care settings were distinct from their colleagues working in acute care settings.