Stressors, moderators and stress outcomes: findings from the All-Wales Community Mental Health Nurse Study

Does self-efficacy mediate the relationship between occupational stress and mental health problems? A study among nursing professionals

Background: While it is acknowledged that self-efficacy plays a significant role in understanding consequences of occupational stress, no research has given much attention to the mediating effect of self-efficacy in the association between occupational stress and mental health (MH)problems. The aims of this study were to examine: (1) the associations between occupational stress, MH problems, and self-efficacy among nursing professionals, and (2) mediating effect of self-efficacy in the association between occupational stress and MH problems.

Methods: A multi-hospital cross-sectional survey was adopted in eight hospitals in Tabriz, Iran. 389 nursing staff were recruited through a two-stage sampling procedure. Study variables included occupational stress (Health & Safety Executive [HSE] Management Standards RevisedIndicator Tool [MS–RIT]), mental health (General Health Questionnaire [GHQ–28]), and self efficacy (General Self-Efficacy [GSE–10]). Generalized structural equation modelling (GSEM)was applied.

Results: Occupational stress (mean±SD=109.2±13.4), poor MH (41.9%), and low selfefficacy (mean±SD=17.7±4.9) were fairly common among the participants. The results showed significant direct effect of occupational stress on MH problems (β=- 0.38, P<0.001). Indirect effect of occupational stress on MH problems through self-efficacy was not significant.

Conclusion: The findings highlight the role of other mechanisms or factors than self-efficacy in the association between occupational stress and MH problems that should be established in future work.

Stigma, Emotion Appraisal, and the Family Environment as Predictors of Carer Burden for Relatives of Individuals Who Meet the Diagnostic Criteria for Borderline Personality Disorder

There is some research exploring carers' experiences within the National Health Service in the UK, but only one has focused on carers of individuals with borderline personality disorder (BPD). Ninety-eight carers completed a questionnaire-based study; 57 carers of individuals who meet the diagnostic criteria for BPD were compared to 41 carers of individuals with other mental health problems. The study aimed to investigate whether perceived stigma, perceived threat of strong emotions, and expressed emotion (EE) within the family environment predicted carer burden. The results showed that carers of those who met the diagnosis for BPD experienced higher levels of carer burden, stigma, EE, emotional over involvement (EOI), criticism (CC), and perceived threat of strong emotions than carers of individuals with other mental health difficulties. EOI, CC, carer group (BPD and mental health), and gender of participant were predictors of carer burden, with EOI explaining the most variance of burden.

Interwoven histories: Mental health nurses with experience of mental illness, qualitative findings from a mixed methods study

The effects of mental health nurses' own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses' lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six-phase approach. The analysis revealed the broad context of nurses' experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses' lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses' mental illness could be much broader than the effect of workplace stress.

What keeps nurses happy? Implications for workforce well-being strategies

AIM

The aim of this article is to present selected findings from a doctoral study on the subjective well-being and subjective experience of mental health problems in UK mental health nurses. Here the concept of 'nurses' well-being' is explored.

METHOD

Data were drawn from a survey of 237 mental health nurses about their mental health and well-being and from interviews with 27 mental health nurses with personal experience of mental health problems and high subjective well-being.

RESULTS

While nurses' subjective well-being is relatively low, some use strategies to support their well-being in and outside the workplace. Activities outside work that improved their wellbeing were physical exercise, mindfulness practice, spending time in nature and listening to music. Well-being was associated with clear boundaries between home and work life, regular clinical supervision and translating learning from work with patients to nurses' own lives.

CONCLUSION

Healthcare employers' staff health and well-being strategies should be informed by nurses' insights into what works for them. This may mean offering opportunities to take part in well-being activities. There are also opportunities to improve staff well-being through shared initiatives open to nurses and patients, and through an inclusive and empowering approach to staff engagement.

Consultant psychiatrists' working patterns

Aims and Method

To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ).

Results

There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts', leading to problematic levels of psychological distress among some consultants.

Clinical Implications

Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts', to reduce attrition in the most pressured individuals.

Clinical Observations About the Potential Benefits and Pitfalls of Between-Session Contacts with Borderline Patients

Borderline Personality Disorder (BPD) has a reputation for being a challenging disorder to treat due to the nature of the illness. With the development of evidence-based treatments, therapists are becoming more skilled at successfully helping this cohort of patients. A common factor associated with all validated treatments for BPD is the active involvement of therapists. For example, DBT is one treatment where therapists are expected to be available to patients for coaching outside of sessions. However, understanding the benefits and pitfalls associated with therapists' accessibility in between sessions is relevant to any treatment with intersession contact. In this article, three benefits of intersession contact are described: to generalize the use of skills, to improve understanding of the patient's needs, and to facilitate an alliance. This article also addresses the pitfalls of therapists being so accessible to patients. Both the benefits and pitfalls of intersession contact are illustrated using case vignettes. Assessing the function served by a patient's contact in between sessions is an important way to determine whether such contact is a productive part of treatment. Recommendations are provided to avoid detrimental outcomes for both the therapist (therapist burnout) and the patient.

Bad Versus Good, What Matters More on the Treatment Floor? Relationships of Positive and Negative Events With Nurses' Burnout and Engagement

Many investigators have reported the stressful aspects of nursing; fewer have focused on nurses' positive work experiences. For this study, we developed a 2 × 2 typology of positive and negative events related to the tasks of nursing work and the social and organizational context of that work: successes, supports, constraints, and conflicts. We hypothesized that positive events would predict engagement, negative events would predict burnout, and negative events would be more strongly related to both burnout and engagement. In secondary analyses of data from 310 acute care nurses who completed survey measures of workplace events at one time point and burnout and engagement measures approximately eight months later, regression results indicated that both positive and negative work events contributed to engagement, whereas only negative events were related to burnout. The results of dominance analyses established that constraints and conflicts more strongly predicted burnout than did supports and successes. Additionally, consistent with a "bad is stronger than good" perspective, the strongest predictor of engagement was lower constraints, although successes, supports, and conflicts also predicted engagement.

CLASSIFICATION OF IRANIAN NURSES ACCORDING TO THEIR MENTAL HEALTH OUTCOMES USING GHQ-12 QUESTIONNAIRE: A COMPARISON BETWEEN LATENT CLASS ANALYSIS AND K-MEANS CLUSTERING WITH TRADITIONAL SCORING METHOD

BACKGROUND

Nurses constitute the most providers of health care systems. Their mental health can affect the quality of services and patients' satisfaction. General Health Questionnaire (GHQ-12) is a general screening tool used to detect mental disorders. Scoring method and determining thresholds for this questionnaire are debatable and the cut-off points can vary from sample to sample. This study was conducted to estimate the prevalence of mental disorders among Iranian nurses using GHQ-12 and also compare Latent Class Analysis (LCA) and K-means clustering with traditional scoring method.

METHODOLOGY

A cross-sectional study was carried out in Fars and Bushehr provinces of southern Iran in 2014. Participants were 771 Iranian nurses, who filled out the GHQ-12 questionnaire. Traditional scoring method, LCA and K-means were used to estimate the prevalence of mental disorder among Iranian nurses. Cohen's kappa statistic was applied to assess the agreement between the LCA and K-means with traditional scoring method of GHQ-12.

RESULTS

The nurses with mental disorder by scoring method, LCA and K-mean were 36.3% (n=280), 32.2% (n=248), and 26.5% (n=204), respectively. LCA and logistic regression revealed that the prevalence of mental disorder in females was significantly higher than males.

CONCLUSION

Mental disorder in nurses was in a medium level compared to other people living in Iran. There was a little difference between prevalence of mental disorder estimated by scoring method, K-means and LCA. According to the advantages of LCA than K-means and different results in scoring method, we suggest LCA for classification of Iranian nurses according to their mental health outcomes using GHQ-12 questionnaire.

Factors Affecting Minor Psychiatric Disorder in Southern Iranian Nurses: A Latent Class Regression Analysis

Background:

Mental health is one of the most important dimensions of life and its quality. Minor Psychiatric Disorder as a type of mental health problem is prevalent among health workers. Nursing is considered to be one of the most stressful occupations.

Objectives:

This study aimed to evaluate the prevalence of minor psychiatric disorder and its associated factors among nurses in southern Iran.

Patients and Methods:

A cross-sectional study was carried out on 771 nurses working in 20 cities of Bushehr and Fars provinces in southern Iran. Participants were recruited through multi-stage sampling during 2014. The General Health Questionnaire (GHQ-12) was used for screening of minor psychiatric disorder in nurses. Latent Class Regression was used to analyze the data.

Results:

The prevalence of minor psychiatric disorder among nurses was estimated to be 27.5%. Gender and sleep disorders were significant factors in determining the level of minor psychiatric disorder (P Values of 0.04 and < 0.001, respectively). Female nurses were 20% more likely than males to be classified into the minor psychiatric disorder group.

Conclusions:

The results of this study provide information about the prevalence of minor psychiatric disorder among nurses, and factors, which affect the prevalence of such disorders. These findings can be used in strategic planning processes to improve nurses’ mental health.

A guide to critiquing a research paper on clinical supervision: enhancing skills for practice

This paper aims to do two things: First, we want to show the reader how to critique a published research paper. The second aim is to take the reader through the various stages of critiquing using a guide. In the paper, we explain at each stage the research terms that can deter the novice critic from reading and understanding the findings in research. From this we hope the reader will have developed an ability to do their own critiquing, so that they are better informed about the quality of research that influences nursing practice. In this paper we have taken a previously published paper on the effectiveness of clinical supervision and undertaken a systematic critique of the merits of this quantitative research using a recognized critiquing framework compiled by Coughlan et al. (2007). Our purpose was twofold: First, we wanted to demonstrate the various stages of critiquing a paper in order that the reader might make an informed judgment of the quality and relevance of the research. The reader/critic is then able to decide whether to use this research in their own practice. Second, we wanted to assist the reader to develop their own critical, analytical skills through methodically appraising the merits of published research. Nursing as an evidence-based profession requires nurses at both pre- and post-registration level to be able to understand, synthesize and critique research, this being a fundamental part of many nursing curricula. These have become core skills to acquire because implementing up-to-date evidence is the cornerstone of contemporary nursing practice. We have provided in this paper a template for critiquing, which is based on our combined experiences as academics specifically in teaching at the bachelor, master's and doctoral levels.

Working with the 'difficult' patient: the use of a contextual cognitive-analytic therapy based training in improving team function in a routine psychiatry service setting

The clinical management of 'difficult' patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with 'difficult' patients reduced professional burnout symptoms, improved patients' service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ) before (T0) and after (T1) CAT training, and at 1-month follow-up (T2). A significant decrease were found, at T2, on the MBI Emotional Exhaustion scores, the SES Availability subscale, the GEQ Attraction to Group-Social and Group Integration-Social, while the MBI-Personal Accomplishment scores increased from baseline.The results of this study suggest that a CAT-based training can facilitate team cohesion and patient engagement with a service and reduce burnout levels among mental health team members dealing with 'difficult' patients.

The effect of stress on health and its implications for nursing

Stress is an important issue within nursing and it is difficult to find agreement among those who are expert in the area regarding a concise definition of stress. Nevertheless stress is seen as a negative feeling affecting people's health either physically and/or psychologically. However, stress is a normal part of life and considered necessary to increase functional capacity, whereas stress over a prolonged period or when extreme can cause distress which may have debilitating effects that reduce work output, increase absenteeism and reduce one's ability to cope with situations. The most important resource in any organisation is the employee; therefore maintaining and supporting their health is vital to ensure their ability to work, maintain standards and continuously improve standards of care. Leadership styles within organisations must facilitate staff to be involved in decision making; thereby staff feel more valued and work in an autonomous way. This article identifies and discusses the effect of stress on health and its relationship to nursing.

Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies

OBJECTIVES

The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14-17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them.

METHODS

We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards.

RESULTS

The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3-31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3-20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%-27.4%) vs. 19.2% (95 CIs 17.1%-21.3%)).

CONCLUSIONS

Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all "stress" surveys.

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

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

Understanding jordanian psychiatric nurses' smoking behaviors: a grounded theory study

Purpose. Smoking is prevalent in psychiatric facilities among staff and patients. However, there have been few studies of how contextual factors in specific cultures influence rates of smoking and the health promotion role of psychiatric nurses. This paper reports the findings of a classical grounded theory study conducted to understand how contextual factors in the workplace influences the smoking behaviors of Jordanian psychiatric nurses (JPNs). Method. Semi-structured individual interviews were conducted with a sample of eight male JPNs smokers at a psychiatric facility in Amman, Jordan. Findings. Constant comparative analysis identified becoming a heavy smoker as a psychosocial process characterized by four sub-categories: normalization of smoking; living in ambiguity; experiencing workplace conflict; and, facing up to workplace stressors. Conclusion. Specific contextual workplace factors require targeted smoking cessation interventions if JPNs are to receive the help they need to reduce health risks associated with heavy smoking.

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

PURPOSE

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

DESIGN AND METHODS

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

FINDINGS

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

PRACTICE IMPLICATIONS

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

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

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

Development of the Psychiatric Nurse Job Stressor Scale (PNJSS)

AIMS

The aim of the present study was to develop a tool, the Psychiatric Nurse Job Stressor Scale (PNJSS), for measuring the stress of psychiatric nurses, and to evaluate the reliability and validity of the PNJSS.

METHODS

A total of 302 psychiatric nurses completed all the questions in an early version of the PNJSS, which was composed of 63 items and is based on past literature of psychiatric nurses' stress.

RESULTS

A total of 22 items from four factors, 'Psychiatric Nursing Ability', 'Attitude of Patients', 'Attitude Toward Nursing' and 'Communication', were extracted in exploratory factor analysis. With regard to scale reliability, the item-scale correlation coefficient was r = 0.265-0.570 (P < 0.01), the Cronbach alpha coefficient was 0.675-0.869, and the test-retest correlation coefficient was r = 0.439-0.771 (P < 0.01). With regard to scale validity, the convergent validity of the 'job stressor' scale was r = 0.172-0.420 (P < 0.01), and the predictive validity of the 'job reaction' scale was r = 0.201-0.453 (P < 0.01). The compatibility of the factor model to the data was 1.750 (χ(2) /d.f., 343.189/196, P < 0.01), the goodness of fit index was 0.910, the adjusted goodness of fit index was 0.883, the comparative fit index was 0.924, and the root mean square error of approximation was 0.050.

CONCLUSIONS

The PNJSS has sufficient reliability and validity as a four-factor structure containing 22 items, and is valid as a tool for evaluating psychiatric nurse job stressors.

Burnout, social support, and job satisfaction among Jordanian mental health nurses

Burnout occurs in occupations, such as nursing, where a significant proportion of time is spent in close involvement with other people. Mental health nursing has been considered an area that is subjected to high levels of burnout. Burnout in mental health nursing affects both individuals and organizations. The purposes of this study were to measure the levels of burnout and identify the correlates of burnout among Jordanian mental health nurses. A descriptive correlational design was used to collect data from mental health nurses using the Maslach Burnout Inventory, Social Support Scale, Job Satisfaction Scale, and demographic and work-related variables through a self-reported questionnaire. The sample consisted of 181 mental health nurses recruited from all mental health settings in Jordan. Jordanian mental health nurses showed high levels of emotional exhaustion and moderate levels of depersonalization and personal accomplishment. Scores of job satisfaction and social support were slightly higher than the midrange. Significant correlations were found among burnout categories, job satisfaction, social support, and demographic and work-related variables. Predictor variables accounted for 32.7% of emotional exhaustion, 27.7% of depersonalization, and 16.8% of personal accomplishment. Results revealed that a comprehensive interventional approach aimed at minimizing the risk of burnout among mental health nurses is needed. Such an approach should involve interventions at both individual and organizational levels.

The effects of potentiality education on potentiality and job satisfaction among psychiatric nurses in Taiwan

PURPOSE

This study evaluated the effects of a potentiality education program on potentiality and job satisfaction among psychiatric nurses.

DESIGN AND METHODS

This quasiexperimental study recruited 59 psychiatric nurses, of whom 26 were assigned to an experimental group, based on their interest in participating in the program, and 33 to a control group.

FINDINGS

The results indicated that the scores for job satisfaction were significantly higher in the experimental group than in the control group. Specifically, potentiality education promoted job satisfaction but had no significant influence on potentiality. PRACTICE APPLICATION: Increasing nurses' potentiality could help them to successfully cope with their large workload and the various challenges of their job.

Psychological morbidity, quality of life and their correlations among military health care workers in Taiwan

To estimate the prevalence of psychological morbidity among health care workers in military hospitals in Taiwan and studies the association between psychological morbidity and quality of life. We sent surveys to 1,269 health care workers working in military hospitals. Participants completed structured questionnaires that included the General Health Questionnaire (GHQ), and the WHO Quality of Life Questionnaire (WHO-QOL). The survey was completed by 65 physicians, 416 nurses, and 304 other specialists. Nurses had the highest GHQ scores (nurses 32.1% vs. physicians 28.3% and other 22.4%). On the WHOQOL, nurses had worse psychological and environment domain scores (12.7 and 13.1, respectively) and physicians scored the worst for the physical and social domain as compared to nurses and other specialists. The younger, hypnotic drug use and life events had higher percentage in psychological morbidity group (Odds Ratio 1.04, 12.5, 2.38; p=0.008, 0.028 and 0.014, respectively). In regression analysis, job category, life event and hypnotic drug use could predict GHQ; age and GHQ could predict QOL (p<0.001). The GHQ might be a mediating factor to QOL. Programs should be developed to educate younger health care workers with psychological morbidity to adjust the stressors associated with their jobs to improve their QOL.

Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross sectional survey

BACKGROUND

The NHS Plan required extensive changes in the configuration of mental health services in the UK, including introduction of crisis resolution teams, CRTs. Little is known about the effects of these changes on mental health staff and their recruitment and retention.

AIMS

To assess levels of burnout and sources of satisfaction and stress in CRT staff and compare them with assertive outreach team (AOT) and community mental health team (CMHT) staff.

METHOD

Cross sectional survey using questionnaires, including the Maslach Burnout Inventory, the Minnesota Satisfaction Scale and global job satisfaction item from the Job Diagnostic Survey. All staff in 11 CRTs in 7 London boroughs were included.

RESULTS

One hundred and sixty-nine questionnaires were received (response rate 78%). CRT staff were moderately satisfied with their jobs and scores for the three components of burnout were low or average. Their sense of personal accomplishment was greater than in the other types of team.

CONCLUSION

Our results suggest that CRTs may be sustainable from a workforce morale perspective, but longer term effects will need to be assessed.

Nurses in abortion care: identifying and managing stress

The psychological impact of abortion on the women undergoing the procedure is well researched, but little is known about the potential psychological impact on nurses working in abortion care. The proportion of medical abortions in the UK is rising compared to surgical abortions. A recent research study found that being more directly involved in the procedure places more emotional demands on the nurses. This emotional labour required by nurses working in abortion care may increase their stress levels. This paper examines the potential increase in stress in nurses caused by medical abortions. A model of stress comprising stressors, moderators and stress outcomes was used as a framework for this examination. Research on abortion and mental health nursing was applied to managing stress in abortion care; this included coping mechanisms, prevention and intervention strategies. This showed that stress, burnout and coping are important issues in abortion care. On this basis, recommendations for practice have been formulated to inform practice for nurses and managers in abortion care.

Workplace stressors and coping strategies among Chinese psychiatric nurses

PURPOSE

This study was conducted with Chinese psychiatric nurses to identify their workplace stressors and coping strategies, as well as the relationships between their demographics, workplace stressors, and coping strategies.

DESIGN AND METHODS

This survey was conducted, with the use of three questionnaires, on 188 psychiatric nurses recruited via convenient sampling in central China.

FINDINGS

The findings indicated that (a) workload and dealing with death/dying were the greatest workplace stressors; (b) positive coping strategies were the most often used coping strategies; and (c) a series of correlation results occurred. PRACTICE APPLICATION: Understanding the relationship between workplace stressors, effective and ineffective coping, and demographics can contribute to designing less stressful environments and more constructive coping strategies.

Professional identity in community mental health nursing: A thematic analysis

AIM

The study aimed to explore how community mental health nurses (CMHNs) UK perceived their working lives. This was subdivided into questions related to: How do nurses perceive their professional status in terms of public image compared with their understanding of their working lives? How does the relationship between professional aspirations and experiences of working life affect their feelings about their work and their self image?

BACKGROUND

In a rapidly changing organizational context CMHNs face the challenge of achieving a coherent professional identity.

METHOD

An interview study was conducted and analyzed using semi-structured interviews and a thematic analysis to identify categories and themes in 34 CMHN's accounts of their working lives.

FINDINGS

The data were classified into four major themes: (i) The client focus: the public service identity of the profession; (ii) Not being a profession: skepticism, doubt and uncertainty; (iii) Growing out of the role: professional development as exit strategy; (iv) Waiting to be discovered: the search for recognition.

CONCLUSIONS

The metaphor of nurses searching for recognition has demonstrated its usefulness as a means of illuminating the quest undertaken by CMHNs to establish the legitimacy of their work, and achieve acknowledgment and appreciation. This underlies the search for professional identity in community mental health nursing.

Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms

The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

An Investigation of the Role of Non–Work-Time Behavior in Buffering the Effects of Work Strain

OBJECTIVE

In this exploratory study, we investigated the extent to which common leisure time behaviors, which generate positive feelings of fulfillment and personal reward, are significant in alleviating work-induced stress between successive work periods. We tested the hypotheses that such activities increase recovery from stress directly, and also by improving sleep quality, thereby alleviating maladaptive outcomes from work strain.

METHOD

An on-line survey study was completed by a heterogeneous sample of 314 workers in diverse occupations, in good health.

RESULTS

Non-work-time behaviors play a significant role in mediating maladaptive outcomes from work strain. Multivariate analysis of these relationships indicates both direct and indirect effects, the latter being associated with mediating sleep quality. Respondents reporting higher levels of active leisure activities, exercise, and creative (hobby) and social activity, reported significantly better sleep, recovery between work periods, and lower chronic maladaptive fatigue symptomology.

CONCLUSION

Active and fulfilling non-work-time behaviors are more significant in maximizing recovery from work strain than is commonly recognized. This effect is arguably due to the downregulation of stress-induced brain arousal, and stimulation of the pleasure-reward brain neurophysiology. Consistent recovery from work strain between work periods may represent a crucial factor in avoiding work-related "loss spirals" leading to maladaptive health outcomes, which can be particularly relevant to workers in inherently stressful occupations.

Mental ability and psychological work performance in Chinese workers

This study was to explore the relationship among mental ability, occupational stress, and psychological work performance in Chinese workers, and to identify relevant modifiers of mental ability and psychological work performance. Psychological Stress Intensity (PSI), psychological work performance, and mental ability (Mental Function Index, MFI) were determined among 485 Chinese workers (aged 33 to 62 yr, 65% of men) with varied work occupations. Occupational Stress Questionnaire (OSQ) and mental ability with 3 tests (including immediate memory, digit span, and cipher decoding) were used. The relationship between mental ability and psychological work performance was analyzed with multiple linear regression approach. PSI, MFI, or psychological work performance were significantly different among different work types and educational level groups (p<0.01). Multiple linear regression analysis showed that MFI was significantly related to gender, age, educational level, and work type. Higher MFI and lower PSI predicted a better psychological work performance, even after adjusted for gender, age, educational level, and work type. The study suggests that occupational stress and low mental ability are important predictors for poor psychological work performance, which is modified by both gender and educational level.

Clinical supervision and burnout: the influence of clinical supervision for community mental health nurses

AIMS

The aim of this study was to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK.

METHODS

The research instruments used were the Maslach Burnout Inventory and the Manchester Clinical Supervision Scale. At the time of the survey 817 community mental health nurses were reported to work within Wales. Two hundred and sixty (32%) community mental heath nurses working in 11 NHS Trusts responded to the survey.

RESULTS

One hundred and eighty-nine (73%) community mental heath nurses had experience of clinical supervision in their present posts and 105 (40%) in their previous posts. The findings from the Maslach Burnout Inventory indicated high levels of emotional exhaustion for 36%, high levels of depersonalization for 12% and low levels of personal accomplishment for 10% of the community mental heath nurses surveyed. Univariate analysis showed that those community mental heath nurses who were younger, male and who had not experienced six or more sessions of clinical supervision were more likely to report cold negative attitudes towards their clients as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. One hundred and sixty-six community mental heath nurses had experienced six or more sessions of clinical supervision and had completed the Maslach Burnout Inventory. Higher scores on the Manchester Clinical Supervision Scale were also associated with lower levels of measured burnout, with significant negative correlations between the total Manchester Clinical Supervision Scale score and the emotional exhaustion subscale (r = -0.148, P = 0.050) and the depersonalization subscale (r = -0.220, P = 0.003) of the Maslach Burnout Inventory. These findings suggest that if clinical supervision is effective then community mental heath nurses are likely to report lower levels of emotional exhaustion and depersonalization.

CONCLUSIONS

The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.

Referral criteria: making the district nursing service visible

The development of referral criteria has been seen as one of the keys to the proactive enhancement of the district nursing service to ensure equity and efficiency of service provision (Audit Commission, 1999). Referral criteria specify what constitutes an appropriate district nursing referral and who is the best person or service to undertake the care if it is not. With the continued focus of shifting the balance of care away from the hospital and into the community and a historically reactive rather than proactive work force, district nurses in Lothian, Scotland developed referral criteria for the service. This article discusses the drivers for the development of these criteria, how they were developed, and the anticipated difference implementation of the criteria would make to district nursing.

The motivation to care

PURPOSE

The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work.

DESIGN/METHODOLOGY/APPROACH

The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation.

FINDINGS

The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations.

ORIGINALITY/VALUE

Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.

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

BACKGROUND

Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained.

AIM

The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies.

METHOD

A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided.

RESULTS

The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies.

CONCLUSIONS

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.