Reviewing nursing stress according to a proposed coping-adaption framework

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

Background:

Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future.

Methods:

We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey.

Results:

We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels.

Conclusion:

As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

Predictors of sustained organizational commitment among nurses with temporary job contracts

OBJECTIVE

To examine sociodemographic, work-related factors and psychological health as predictors of sustained organizational commitment among temporary hospital employees.

BACKGROUND

The participants were 412 nurses who had a temporary job contract and reported being committed to their organization at baseline.

METHODS

Organizational commitment was measured again 2 years later.

RESULTS

The results of logistic regression analysis showed that age over 35 years, high job control, high participative safety, high perceived justice in decision making, and low psychological distress predicted sustained organizational commitment at follow-up. The change from temporary employment to a permanent job and high job control predicted sustained organizational commitment even after the effect of all the other predictors was taken into account.

CONCLUSION

Organizations that employ temporary workers should pay attention to the job control and career prospects of temporary staff.

Satisfação no trabalho - uma breve revisão

Este artigo tem o objetivo de apresentar uma breve revisão sobre satisfação no trabalho, analisando suas diferentes concepções. Associadas a essas concepções, também são apresentadas características do trabalho que interferem e determinam a satisfação, bem como as conseqüências da satisfação e da insatisfação no ambiente de trabalho.

The diversity of work: differences, similarities and relationships concerning characteristics of the organisation, the work and psychological work reactions in intensive care and non-intensive care nursing

The aim of this study was to examine differences in organisational characteristics, work characteristics and psychological work reactions, and to investigate relationships between these variables in intensive care units (ICUs) and non-ICUs. Questionnaires were distributed to intensive care (n = 184) and non-intensive care nurses (n = 927) working in 15 general hospitals in the Netherlands. MANOVA showed that ICU nurses reported significantly higher uncertainty, higher complexity, and higher decision authority than non-ICU nurses. Emotional exhaustion was significantly lower among ICU nurses. Regarding the pattern of relationships, the LISREL-analyses revealed that the indirect proposed pattern of relationships was invariant across the two samples, which means a validation of our research model.

A preliminary analysis of psychophysiological variables and nursing performance in situations of increasing criticality

OBJECTIVE

To examine the relationship between psychological, physiological, and performance variables in intensive care unit (ICU) nurses in situations of increasing criticality.

SUBJECTS AND METHODS

Psychophysiological variables and endotracheal suctioning performance were examined in a classroom, a skills laboratory, and an ICU. Situation-specific anxiety (state anxiety) and the predisposition to view situations as threatening (trait anxiety), cognitive appraisal, and heart rate were measured and compared with self-appraisal and a nurse instructor's ratings of suctioning performance. Baseline data were obtained during class on 45 novice ICU nurses.

RESULTS

Twenty-six nurses provided complete data, which included being videotaped and monitored in the classroom, in the skills laboratory performing endotracheal suctioning, and in the ICU during suctioning. High state anxiety significantly predicted poor ICU suctioning performance (P<.04). Nurses high in state and trait anxiety, worry, and heart rate performed poorly compared with less anxious nurses. Nurses in this study who performed best had a mean heart rate of 94 beats/min.

CONCLUSION

Those nurses who are high state anxious, high trait anxious, and worried and who had a faster heart rate performed less well than their more relaxed peers. Nurses with high state anxiety may be at risk for attrition, burnout, medical errors, and poor performance in other ICU nursing tasks.

Stress in perioperative nursing: sources, frequency and correlations to personality factors

Psychological stress in perioperative nursing is a complex phenomenon that is often reported in the literature as having potentially detrimental consequences. However, little specific research has been conducted into the causes and possible mediating processes involved in the stress response. The aims of this pilot study were firstly, to identify the range of stressors encountered by a group of perioperative nurses (n = 47) and secondly, to investigate the relationship of the reported interpersonal stressors to the personality construct of lifestyle proposed by individual Psychology (IP). The results of the study indicate that the major stressors experienced by this group of perioperative nurses are related to interpersonal conflict, organisational issues, equipment availability and workload. Interpersonal conflict was the leading stressor and the construct of lifestyle was significantly correlated with nurses' psychological stress in specific difficult interpersonal conflict situations. The implications of the findings include the possibility of developing interventions based on IP that may assist nurses to better deal with interpersonal conflict in the perioperative setting and to possibly reduce their stress responses in frequently encountered difficult interpersonal situations.

Investigating stress effect patterns in hospital staff nurses: results of a cluster analysis

A comprehensive and reliable assessment of work stress, burnout, affective, and physical symptomatology was conducted with 260 hospital nurses. As previous attempts to categorize nursing stress and burnout by ward type have yielded inconsistent results, an alternative method for grouping nursing stress effects was sought. Cluster analysis was chosen as it offers a statistically sound means of delineating natural groupings within data. Sets of questionnaires measuring burnout, work stressors, and physical and emotional symptomatology were sent to all staff nurses at a large university hospital. Of 709 nurses employed there, a total of 260 nurses returned completed questionnaire packets. These nurses were separated into two equal groups using random sampling procedures. Cluster analysis of this data revealed groupings which were based on nursing stressors (particularly workload and conflict with physicians), social support, and patient loads. These cluster-analytic findings were replicated on both samples, and validated using data not used in the original cluster analysis. Results suggest that the effects of stress have more to do with the characteristics of the work environment and overall workload than with the degree of specialization on the unit. Results also suggest that intraprofessional conflict (i.e. with other nurses) is less psychologically damaging than is interprofessional conflict (i.e. conflict with physicians). Findings are discussed with respect to the burnout process and possible interventions.

The development of a nurse stress checklist from English to Chinese version

Work stress has been identified as a relevant problem in the field of professional nursing. Many instruments measuring nurse work stress have already been developed in the United States. The Nurse Stress Checklist (NSC), a Likert-type questionnaire with 47 items, was selected for adaptation into the Chinese language from among these instruments, following a literature review and a comparison with the author's personal nursing experiences. The processes of developing the validity of an NSC Chinese version--content validity, concurrent validity, and construct validity--were conducted. In this pilot study, 13 Chinese nurses who had previously worked in the United States and who were fluent in both Chinese and English filled out the NSC in both the Chinese and English versions. Pearson's correlation was performed to build up concurrent validity. Next, 138 Chinese nurses were randomly selected from three medical centers in Taiwan to be participants in the major study. They filled out the NSC in the Chinese version, and a factor analysis was used to build up construct validity. Four factors were extracted: nonproductive reactions, satisfactory responses, professional concerns, and falling behind. A comparison was made of these four factors with the five factors of the NSC in the English version.

Stress management for nurses: controlling the whirlwind

This paper proposes that nurses can manage stress in their lives through a well-integrated, flexible program. A person's stress reaction is compared to a whirlwind, with negative outcomes that may vary from mild to devastating. The emphasis here is that these negative consequences can be minimized by applying different levels of intervention strategies to each phase in the progression of the stress reaction. A variety of strategies for coping with stress are presented here from which a person may select and build a personal repertoire of interventions for stress management.

Nurses and physicians evaluate their intensive care experiences

OBJECTIVE

Analysis of the evaluation of intensive care experiences of nurses and physicians in relation to their educational background and degree of professionalization.

DESIGN

Cross-cultural, qualitative study design: German nurses and physicians and American nurses.

SETTING

German medical intensive care unit (nine beds), German surgical intensive care unit (six beds), and an American medical-surgical intensive care unit (16 beds).

SUBJECTS

Thirteen German nurses (eight women, five men) of a medical intensive care unit, six German nurses (five women, one man) of a surgical intensive care unit, nine German physicians of a medical intensive care unit (two women, seven men), and 13 American nurses of a medical-surgical intensive care unit (10 women, three men).

METHODS

The interviewing technique by the method of Role Repertory Grid Test by G.A. Kelly. We focused on important job experiences in intensive care and the remembered evaluation of these experiences.

RESULTS

The reported experiences of intensive care unit nurses and physicians show negative as well as positive appraisals. No correlation can be shown between negative appraisals and the degree of professionalization or training of German nurses and physicians, and American nurses, respectively. The qualitative-content analysis of positively appraised experiences does indicate, for all four studied groups, that even primarily so-called "positive" experiences are closely connected with negative aspects and connotations.

CONCLUSIONS

The results indicate that nurses and physicians experience intensive care work with extreme ambivalence. To be content with and successful on the job it appears necessary to develop a high level of ambivalence. From a methodologic point of view, the advantages of the interviewing technique (Role Repertory Grid) are discussed.

Holding on: parents' perceptions of premature infants' transfers

OBJECTIVE

To describe parents' perceptions of their infants' transfers within a regional system of perinatal care.

DESIGN

Qualitative; grounded theory methodology.

SETTING

Interviews were conducted in an office adjacent to a neonatal intensive care unit (NICU), in an intermediate care unit (IMCU), and in the homes of parents.

PARTICIPANTS

Fifteen parents of premature infants were recruited and interviewed during the 3 days before their infants were transferred from a NICU to an IMCU or home. The 15 parents were interviewed again during the 5 days after the initial interview to learn their feelings about the transfer.

DATA COLLECTION

After consent was obtained, unstructured interviews were recorded and transcribed. Analyses of the data were ongoing, and the second interviews with parents were more focused.

RESULTS

Parents identified four phases that described their transfer experience. Within the four phases, four categories were identified to depict parents experiences further. The core category of holding on reflected the belief that transfer home would become a reality and normal family life eventually would ensue.

CONCLUSIONS

Nurses in NICUs and IMCUs have a responsibility to educate the parents of infants at high risk. Nurses sensitive to parental perceptions of neonatal transfer can better facilitate a positive transfer experience.

Factors related to nursing burnout: a review of empirical knowledge

It has been observed that nurses are at a high risk of burnout. The initiator variables of burnout appear to be numerous, tenacious, and not isolated; burnout is a complex phenomenon with multiple dimensions. In order to prevent psychosocial dysfunction and promote the mental health of nurses, the predominant factors contributing to nursing burnout should be clear. This article presents a literature review of the existing empirical knowledge regarding factors related to burnout in nurses. Among 300 documents on nursing burnout, 36 pertinent studies were retained. Amid these studies, 15 variables were selected, classified, and critically analyzed. It appears that the best correlates of nursing burnout are role ambiguity, workload, age, hardiness, active coping, and social support. Probable relationships and influences among these factors are discussed and may lead to a better understanding of mutual interactions between the personal and environmental factors contributing to nursing burnout. Implications for practice and further research are proposed.

Curriculum Issues Related to Nurse Turnover

The problem of turnover rates among registered nurses has implications for nursing curriculum and for continuing education programs. After a brief presentation of turnover issues, curriculum implications will be discussed under three broad areas: (a) content about turnover included in nursing management textbooks; (b) nursing curriculum issues that influence the survivability of graduates of schools of nursing and thereby affect turnover rates; and (c) continuing education needs of registered nurses. This paper is not a summary of solutions for turnover. The problem of turnover is complex and poorly understood. The curricular issues provide challenges to traditional nursing education that would increase the likelihood of the development of "hardy" nurse graduates who have survival skills for the practice environment.

Systematic clinical supervision in a child psychiatric ward: satisfaction with nursing care, tedium, burnout, and the nurses' own report on the effects of it

The effects of systematic clinical supervision on all nurses (n = 11) at a ward for child psychiatric care was evaluated by means of open-ended questions, the tedium measure, Maslach's burnout inventory (MBI), and the satisfaction with nursing care at baseline, and after 6 and 12 months of supervision. Two main themes emerged: (1) being understood and understanding others led to improved cooperation and self-confidence and, (2) broadened and better knowledge base led to increased goal-oriented and active nursing actions in their clinical work. The nurses' satisfaction increased significantly regarding responsibility, organization, quality of care, cooperation, and comfort in the work group. The degree of tedium decreased significantly regarding mental exhaustion, whereas there were no significant changes in the degree of burnout as measured by MBI. The data point to the fact that systematic clinical supervision may be a way to show and use the knowledge embedded in practice and to improve the efficiency, the climate, and the cooperation of a work group.

Chinese nurse stress in Taiwan, Republic of China

An exploratory study was conducted to understand the Chinese nurses' perceptions of their work stress in Taiwan, Republic of China (ROC). Data were based on the written answers to two open-ended questions from the randomly selected Chinese nurses working at 3 of the 10 first-ranked teaching hospitals that had 900-2,000 hospital beds. The findings showed that stressors in work situations for Chinese nurses were similar to those of their Western colleagues in four categories: nursing care related to patient condition, interpersonal relationships, workload, and opportunity for promotion. In addition, the Chinese respondents especially identified pressure in the role of a unit educator as stressful. Any troubled interpersonal relationship of the Chinese nurse may have been experienced as a greater source of pressure than nurses in other cultures. It is suggested that there might be some similar stressors in the nurse work situation when comparing the Chinese nurse working in the modern hospital in Taiwan to the nurses in large hospitals in the Western culture. Yet the difference between these nurses was the greater emphasis the Chinese nurses placed on the value of advanced study and interpersonal harmony.

Perceived sources of stress among pediatric oncology nurses

This study examined the stressors most commonly experienced by pediatric oncology nurses. A descriptive, correlational design was used, and Selye's stress theory served as the theoretical framework. The final sample consisted of 155 members of the Association of Pediatric Oncology Nurses who completed and returned the Spielberger State-Trait Anxiety Inventory, and the Pediatric Oncology Nurse Stressor Questionnaire (PONSQ). The participants reported that relapse or sudden death of a favorite patient was their greatest source of stress. The second most common stressor was a workload perceived as too great to give quality patient care. The participants reported no more state or trait anxiety than the reference group. Statistics for white-collar working women were used as the reference group by Spielberger. The PONSQ shows that pediatric oncology nursing is a stressful profession. Additional research is needed to identify positive strategies for reducing this stress.

Effects of relaxation training, combining imagery, and meditation on the stress level of Chinese nurses working in modern hospitals in Taiwan

The purpose of this study was to test the effectiveness of relaxation training, which was based on the cognitive-behavioral model and specifically focused on helping Chinese registered nurses employed in large teaching hospitals to reduce their work stress in Taiwan, Republic of China. The study design was a pretest-posttest control design with two posttest points. The 137 subjects were selected randomly from three first-ranked teaching hospitals. Twenty-three subjects in the experimental group and 23 in the control group from each hospital participated in the study. The treatment of the experimental group consisted of two sessions of relaxation training based on Smith's (1988) cognitive behavioral model of relaxation at weeks 1 and 2, with a follow-up session in the fifth week. The control group had the same sequence of sessions with a presentation by the researcher on theory analysis in nursing. The mean scores on the Nurse Stress Checklist (NSC) and the Chinese General Health Questionnaire (CGHQ) differed significantly between the experimental and control group in posttest 2 at week 5. These results supported the hypotheses that the relaxation training decreased the Chinese nurses' self-reported work stress as measured by NSC and increased the Chinese nurses' self-reported psychophysiologic health as measured by CGHQ. The significant difference on means of the CGHQ in posttest 1 at week 2 showed that the self-reported psychophysiologic health level responded to the relaxation training earlier than to the self-reported work stress level. In the relaxation treatment, duration of practice was an important factor of the effectiveness of the treatment on the dependent variable of NSC. It is suggested that even brief teaching of relaxation techniques may reduce work stress levels and promote a sense of psychophysiologic health in Chinese nurses who are employed in large teaching hospitals in Taiwan.

Hospital staff members are satisfied with their jobs

Job related satisfaction was evaluated by registered nurses, physicians, nurse assistants and aids at an internal medicine clinic at a university hospital in Sweden. A questionnaire concerning cooperation, work load, support, independence and other work related factors was developed and filled out by 153 individuals. The results mostly show high job satisfaction in all professional groups. Nevertheless, nearly half of the staff wanted to quit their jobs. Those who planned to leave their jobs perceived themselves as less satisfied with such factors as cooperation, job complexity, help received from superiors and sufficient time for care delivery, than did those who did not plan to quit. The differences were most evident in the group of registered nurses. The head nurse appeared to have an important supportive function. In conclusion, the results suggest that a supportive organization might reduce personnel turnover in hospitals.