Stress and coping in Australian nurses: a systematic review

Infection prevention and control professionals: Stress, resilience, personality traits and views about their workforce and profession

BACKGROUND

The COVID-19 pandemic placed considerable strain on the infection control professional workforce, who were at the forefront of pandemic response in their organisations and beyond. In order to support infection control professionals and inform future initiatives, it is important to further understand the infection control workforce. The objective of this study was to determine stress and resilience levels, personality traits and workforce intentions of infection control professionals in Australia and New Zealand.

METHODS

We undertook an anonymous, cross-sectional online survey of infection control professionals in Australia and New Zealand. Validated tools, the brief resilience tool, workforce stressor tool and the Big Five personality test, were used to evaluate levels of stress, resilience and personality traits.

RESULTS

Three hundred and fifty-six infection control professionals started the survey, with representation from all Australian jurisdictions and New Zealand. The mean stress score was 4.28 (SD 3.39) and 3.34 (SD 0.65) for resilience. Younger participants and those with less experience in infection control had higher levels of stress and lower levels of resilience. Individual personality traits vary by age, level of education and credentialing status. Approximately one-fifth of participants indicated that they planned to leave the IC workforce in the next three years.

CONCLUSIONS

Our study was the largest published study involving infection control professionals in Australia and New Zealand. Findings highlight the need for mentoring, peer support and wellbeing initiatives to support the profession. Understanding personality traits may also be beneficial for further enhancing communication and interpersonal relationships.

Exploring the effects of delivering CPR on nurses' mental health and well-being

Nurses are often first responders to patients in cardiac arrest and therefore have a critical role in delivering cardiopulmonary resuscitation (CPR), which can be physically, emotionally and ethically demanding and highly stressful. The stress of being involved in patient resuscitation is widely acknowledged, but there is limited research on how nurses cope during and after delivering CPR. This qualitative literature review aimed to develop an understanding of the effects of delivering CPR on nurses' mental health and well-being. The thematic synthesis of the 15 studies reviewed identified three main themes: work-related stress, burnout, and psychiatric morbidity. These all adversely affect nurses' mental health and well-being, and potentially the effectiveness of their delivery of CPR, and are implicated in nurse attrition. There is a need for stress-reduction programmes and strategies to enhance nurses' coping skills and for the provision of multidisciplinary training that supports effective teamwork and nurses' delivery of CPR.

Effectiveness of emotional intelligence training on nurses' and nursing students' emotional intelligence, resilience, stress, and communication skills: a systematic review and meta-analysis

AIMS

This study evaluates the effectiveness of emotional intelligence training on emotional intelligence, resilience, stress, and communication skills among nurses and nursing students.

DESIGN

We conducted a systematic review and meta-analysis of the effectiveness of emotional intelligence training in nurses and nursing students.

DATA SOURCES

Randomised controlled trials were searched in MEDLINE (via PubMed), CINAHL (via EBSCOhost), Web of Science (via Ovid), ERIC (via ProQuest), Cochrane Central Register of Controlled Trials (CENTRAL), and Igaku Chuo Zasshi databases from inception to 9-11 October 2024.

REVIEW METHODS

Two authors independently screened each study and assessed eligibility. Authors calculated the pooled effect estimates associated with nurses' and nursing students' emotional intelligence, resilience, stress, and communication skills using a random-effects meta-analytic model.

RESULTS

The search yielded 1731 studies from electronic databases. After removing duplicates, 1294 records remained. Following title and abstract screening, 34 studies qualified for full-text review, of which 11 studies were excluded based on inclusion criteria, leaving 23 studies for analysis. Emotional intelligence training significantly improved emotional intelligence compared to the control group (16 trials, N = 1155; SMD = 1.76 [95 % CI: 1.06 to 2.45]). It also had a significant effect in reducing stress (4 trials, N = 312; SMD = -1.51 [95 % CI: -2.96 to -0.07]) and demonstrated a significant positive effect on communication skills (4 trials, N = 329; SMD = 2.72 [95 % CI: 0.64 to 4.79]). However, it had no significant effect on resilience (2 trials, N = 138; SMD = 2.71 [95 % CI: -1.55 to 6.97]).

CONCLUSIONS

This study found that emotional intelligence training had a statistically significant positive impact on enhancing emotional intelligence in nursing students and nurses in both the short and long term. It also significantly reduced stress and improved communication skills but had no significant effect on resilience.

Personality preferences and stress perception among nursing students in different nursing programmes: a cross-sectional study

BACKGROUND

Understanding personality preferences is crucial for guiding healthcare education and the stress management strategies of nursing students. While stress in nursing education has been well studied, its relationship with personality preferences, particularly in clinical settings, has been underexplored. This study aims to investigate the relationship between personality preferences and stress perception among nursing students in three different nursing programmes.

METHODS

This cross-sectional study recruited 780 nursing students. We used structured questionnaires to collect data on demographics, personality preferences, and stress perception. The Myers-Briggs Type Indicator (MBTI) was used to measure personality preferences across four dimensions: extraversion/introversion, sensing/intuition, thinking/feeling, and judging/perceiving. The Chinese version of the MBTI and the Nurse Stress Checklist were also employed. Statistical analyses included descriptive statistics, one-way analysis of variance, and independent t-tests.

RESULTS

Three common personality preferences were identified: extraversion, intuition, feeling, and perceiving; introversion, sensing, thinking, and judging; and introversion, sensing, feeling, and judging. The findings indicate that stress was significantly related to personality preferences. There were significant differences in the stress scores and the extraversion/introversion and thinking/feeling subscales. However, no significant differences in stress levels were observed across different nursing programmes.

CONCLUSIONS

Each personality trait exhibited specific stress coping mechanisms. Addressing students' stress is crucial because it can lead to academic burnout and attrition. This study's findings can inform strategies to reduce stress while accommodating students' personality traits, ultimately enhancing student success in nursing programmes.

Evaluation of Resilience and Stress Coping Styles of Primary Care Nurses During the COVID-19 Pandemic

This study aimed to investigate the resilience, stress levels, coping styles, and the impact of related factors among nurses working in primary healthcare during the COVID-19 pandemic. Designed as a cross-sectional study, the research included 86 volunteer nurses employed in primary healthcare institutions in Bitlis provincial center and its districts in Turkey. Data were collected between March and June 2022 using a sociodemographic information form, the Resilience Scale for Adults, and the Ways of Coping Questionnaire. The results showed that the mean scores of the resilience and stress-coping scales were significantly influenced by the educational and economic status of the nurses. A positive but weak correlation was observed between resilience and the self-confidence and optimistic approach subscales of the Ways of Coping Questionnaire. In contrast, a negative but weak correlation was found between resilience and the helpless and submissive approach subscales. The study revealed an association between resilience levels and stress-coping styles among nurses. Nurses with higher levels of education and income demonstrated greater resilience, while those with lower levels of education and income tended to use passive coping styles. The study recommends intervention programs to increase nurses' psychological resilience and promote effective stress-coping methods. Further research is suggested across professions, institutions, cities, and countries to explore differences in primary care during the COVID-19 pandemic.

The perceived workload of first-line healthcare professionals during neonatal resuscitation

Background

Neonatal resuscitation is stressful for healthcare professionals as measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Little is known regarding the perceived workload and associated factors among healthcare professionals including medical doctors (MDs) and nurses/midwives who have differences in training and experiences. We aimed to characterize and compare the perceived workload between MDs and nurses/midwives who provided neonatal resuscitation.

Methods

In a prospectively designed, cellphone-based surveillance, perceived workload and stress of MDs and nurses/midwives during neonatal resuscitation was evaluated using a modified multi-dimensional NASA-TLX survey in three tertiary Neonatal Intensive Care Units in China. The NASA-TLX data on mental, physical, temporal demand, performance, effort, and frustration were independently rated by participants and collated to a composite score of all dimensions. Demographics of participants and deliveries were also collected for statistical analyses using univariate comparison and multiple linear regression.

Results

From 410 valid surveys (187 (46%) MDs; 223 (54%) nurses/midwives), significant differences were noted between MDs and nurses/midwives including working years and dimensional and overall NASA-TLX scores. While MDs had lower overall NASA-TLX scores than nurses, their scores were inversely related with simulation-based training. More team members presence during resuscitation was associated with higher NASA-TLX scores. Other independent factors associated with NASA-TLX scores included gestational age, Apgar score at 1 min, year of practice for MDs and all resuscitation questions asked by nurses/midwives.

Conclusions

MDs and nurses/midwives attending deliveries had different perceptions in workload and stress which could be lowered from simulation-based training in neonatal resuscitation.

How a critical care environment influences nurses' health and working capacity: a scoping review

BACKGROUND

Internationally, the nursing workforce is ageing. Chronic conditions are becoming more prevalent amongst the ageing nursing workforce. With an increase in chronic conditions and an ageing nursing workforce, understanding environmental influences on nurses' health and work capacity is vital to supporting this workforce.

AIM

A scoping review was conducted to explore the influence of a critical care environment on nurses' health and work capacity.

DESIGN

A scoping review was conducted according to PRISMA-ScR guidelines.

METHODS

Database extraction occurred in June 2023 and included MEDLINE Complete, PubMed, Scopus, CINAHL, and Embase.

RESULTS

Eight studies met the inclusion criteria. Studies were conducted internationally with sample sizes from 20 to 500 critical care nurses (CCNs).

CONCLUSIONS

Findings identified the critical care environment had an impact on nurses' health and working capacity. Many CCNs self-reported having a chronic condition that influenced their nursing practice. Further research is needed to explore how to mitigate the influence of a chronic condition to support this valuable workforce.

Stress dimensions, patterns of coping, and psychopathological risk among nurses: a person-centred approach

BACKGROUND

Nurses are increasingly demanded to achieve gold-standards of care with fewer resources. Dealing effectively with stress experienced in their daily-work-life is thus crucial. This study is based on the Demands-Resources-and-Individual-Effects (DRIVE) Nurses Model and applied the person-centred approach with a twofold objective: 1. to identify patterns of coping strategies (Problem-Focused; Seek-Advice; Self-Blame; Wishful-Thinking; Escape/Avoidance) adopted by nurses to deal with perceived stress; 2. to explore potential differences in perceived Demands (Effort), Resources (Rewards, Job-Control, Social-Support), and Psychopathological Symptoms (Anxiety, Phobic-Anxiety, Obsessive-Compulsive, Somatization, Depression, Interpersonal-Sensitivity, Hostility, Psychoticism, Paranoid-Ideation) according to the emerged patterns.

METHOD

This cross-sectional study was reported by using the STROBE Checklist. Overall, 265 nursing professionals completed self-report measures. Non-hierarchical k-means-cluster-analysis was employed to derive patterns of coping. MANOVAs were used to test differences in Demands, Resources, and Psychopathological Symptoms according to the emerged patterns.

RESULTS

Three stable and meaningful patterns of coping were identified and labelled as Active/Solution-Oriented, Dysregulated/Emotion-focused, and Passive/Disengaged. Nurses belonging to Dysregulated/Emotion-focused group emerged to be at higher risk (higher effort/psychopathological suffering; lower resources) - followed by Passive/Disengaged group - in comparison with nurses belonging to Active/Solution-Oriented group.

CONCLUSION

Fostering nurses' awareness of their latent coping patterns and supporting active approaches/emotional regulation strategies for stress management should represent a key goal when defining interventions promoting nurses' health within/beyond the healthcare settings.

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients

OBJECTIVE

A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology.

METHODS

Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated.

RESULTS

Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator.

CONCLUSION

Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment.

PRACTICE IMPLICATIONS

The clinical and educational importance of empathy in patient-provider relationships are discussed.

Cardiovascular nurses and organizational well-being: a systematic review

AIMS

This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it.

METHODS AND RESULTS

The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive.

CONCLUSION

Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes.

REGISTRATION

PROSPERO: CRD42022355669.

Mediating effect of psychological capital on the relationship between mental health literacy and coping styles among newly recruited nurses

BACKGROUND

Newly recruited nurses face multiple sources of stress and their coping styles need to be focused on to ensure good mental health. This study aimed to examine the relationship among mental health literacy, psychological capital and coping styles in newly recruited nurses.

METHODS

A cross-sectional study was conducted in August and September 2022. A total of 315 newly recruited nurses were recruited in a tertiary hospital in Henan Province, central China, employing the convenience sampling method. The self-reported questionnaires were sent through a QR code, including the Mental Health Literacy Scale for Healthcare Students, Psychological Capital Questionnaire, and Simplified Coping Style Questionnaire. Pearson correlation analysis was used to evaluate the relationships among the variables. Mediation analysis was performed to identify the mediating effect of psychological capital on the relationship between mental health literacy and coping styles.

RESULTS

Positive coping showed a positive relationship with psychological capital and mental health literacy, while negative coping showed a negative relationship with psychological capital and mental health literacy. For positive coping, psychological capital was a partial mediator with an effect of 0.140, accounting for 62.8%. For negative coping, a full mediating effect was shown by psychological capital between mental health literacy and negative coping, with an indirect effect of -0.048.

CONCLUSION

Psychological capital plays a partial and complete mediating role between mental health literacy and different coping styles among newly recruited nurses. Diversified training and personalized guidance in improving mental health literacy and increasing psychological capital simultaneously can be provided to newly recruited nurses continuously to adjust their coping styles.

Factors associated with health professionals' stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations.

BACKGROUND

Health professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations).

METHODS

This study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals' stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep.

RESULTS

The main findings reveal that the incompatibility of health professionals' work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor's good leadership qualities were also associated with health professionals' job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda

AIM

This study aimed to assess chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda, conducted between May and June 2022.

DESIGN

Institutional-based cross-sectional design conducted between May and June 2022.

METHODS

The study included 498 participants recruited from six health facilities. A 12-Item Short Form Survey tool was used to collect data on chronic stress, while a researcher-developed questionnaire was used to collect data on coping strategies. Descriptive statistics, binary logistic regression and multiple regression were conducted for data analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

Out of 498 participants, 153 (30.7%) were aged between 31 and 40 years, 341 (68.5%) were female, 288 (57.8%) were married, and 266 (53.4%) had less than Diploma. Of the 498 participants, 351 (70.5%) experienced chronic stress. The protective factors against chronic stress were being married (AOR: 0.132; 95% CI: 0.043-0.408; p < 0.001), optimizing shift length (AOR: 0.056; 95% CI: 0.027-0.115; p < 0.001), religiosity/Spirituality (AOR: 2.750; 95% CI: 1.376-5.497; p = 0.004), and regular exercise and breaks (AOR: 0.405; 95% CI: 0.223-0.737; p = 0.003).

Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels

Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave)

Introduction

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs.

Methods

During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors.

Results

Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing.

Conclusion

This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial

BACKGROUND

Causes and consequences of chronic stress levels in the context of healthcare work are well examined. Nevertheless, the implementation and evaluation of high-quality interventions to reduce stress of healthcare workers is still missing. Internet and app-based interventions are a promising venue for providing interventions for stress reduction to a population that is otherwise difficult to reach due to shift work and time constraints in general. To do so, we developed the internet and app-based intervention (fitcor), a digital coaching of individual stress coping for health care workers.

METHODS

We applied the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement as a guideline for the present protocol. A randomized controlled trial will be conducted. There are five different intervention groups and one waiting control group. To achieve the sample sizes required by power analysis (G*Power) (β-error 80%; effect size 0.25), the sample sizes of the respective scenarios will be at best as follows: 336 care workers from hospitals, 192 administrative health personnel, 145 care workers from stationary elderly care homes, and 145 care workers from ambulatory care providers in Germany. Participants will randomly be assigned to one of five different intervention groups. A crossover design with a waiting control group is planned. Interventions will be accompanied by three measurement points, first a baseline measure, second a post-intervention measure directly after completion of the intervention, and a follow-up measure 6 weeks after completion of the intervention. At all three measurement points, perceived team conflict, work-related experience patterns, personality, satisfaction with internet-based training, and back pain will be assessed using questionnaires, as well as heart rate variability, sleep quality, and daily movement will be recorded using an advanced sensor.

DISCUSSION

Workers in the health care sector increasingly face high job demands and stress levels. Traditional health interventions fail to reach the respective population due to organizational constraints. Implementation of digital health interventions has been found to improve stress coping behavior; however, the evidence in health care settings has not been established. To the best of our knowledge, fitcor is the first internet and app-based intervention to reduce stress among nursing and administrative health care personnel.

TRIAL REGISTRATION

The trial was registered at DRKS.de on 12 July 2021, registration number: DRKS00024605.

Using a cognitive framework with nurses to manage stress

Nursing can be a stressful occupation with many nurses struggling to cope with stress on a day-to-day basis. Considerable evidence suggests that positive coping strategies can be an effective part of stress management education programs. This article describes the theoretical rationale for a cognitive framework for stress management that was developed as part of a well-being educational program for cancer nurses. This framework included an associated mnemonic (www.pst) to assist in the recall and utilization of positive coping strategies. The stress management framework was intended to increase nurses' perceptions of personal control which is central to stress management. The academic coping literature is complex, jargon laden and often conceptually abstract, and may not easily be understood by a nonacademic audience. The cognitive framework described here is an evidence-based, user-friendly tool that could be used and evaluated by counsellors, educators, and researchers in different settings.

Efficacy of Individualized Sensory-Based mHealth Interventions to Improve Distress Coping in Healthcare Professionals: A Multi-Arm Parallel-Group Randomized Controlled Trial

Detrimental effects of chronic stress on healthcare professionals have been well-established, but the implementation and evaluation of effective interventions aimed at improving distress coping remains inadequate. Individualized mHealth interventions incorporating sensor feedback have been proposed as a promising approach. This study aimed to investigate the impact of individualized, sensor-based mHealth interventions focusing on stress and physical activity on distress coping in healthcare professionals. The study utilized a multi-arm, parallel group randomized controlled trial design, comparing five intervention groups (three variations of web-based training and two variations of an app training) that represented varying levels of individualization to a control group. Both self-reported questionnaire data (collected using Limesurvey) as well as electrocardiography and accelerometry-based sensory data (collected using Mesana Sensor) were assessed at baseline and post-intervention (after eight weeks). Of the 995 eligible participants, 170 (26%) completed the post-intervention measurement (Group 1: N = 21; Group 2: N = 23; Group 3: N = 7; Group 4: N = 34; Group 5: N = 16; Control Group: N = 69). MANOVA results indicated small to moderate time-by-group interaction effects for physical activity-related outcomes, including moderate to vigorous physical activity (F(1,5) = 5.8, p = ≤0.001, η2p = 0.057) and inactivity disruption (F(1,5) = 11.2, p = <0.001, η2p = 0.100), in the app-based intervention groups, but not for step counts and inactivity. No changes were observed in stress-related heart rate variability parameters over time. Despite a high dropout rate and a complex study design, the individualized interventions showed initial positive effects on physical activity. However, no significant changes in stress-related outcomes were observed, suggesting that the intervention duration was insufficient to induce physiological adaptations that would result in improved distress coping.

Work-Family Balance and Managing Spillover Effects Communicatively during COVID-19: Nurses' Perspectives

Work-family balance has received meaningful attention from researchers and practitioners alike. Work and family are usually seen as two separate domains that are interdependent, with boundaries that have some level of permeability. Crisis situations can alter permeability of these boundaries, enhancing integration of the two domains due to exchange of ideas and spillover of concerns between these domains. This study looks at how these boundaries are impacted for nurses working directly with COVID-19 patients. The study conducted 24 semi-structured interviews with nurses. Through a thematic analysis the study found that the work-family boundaries have blurred due to concerns around the contagiousness and anxiety associated with the virus. In order to cope with these spillover and possible crossover effects, nurses use prosocial distortion and avoidance and create sub-boundaries at home.

It's What We Do: Experiences of UK Nurses Working during the COVID-19 Pandemic: Impact on Practice, Identity and Resilience

The COVID-19 pandemic increased pressure on a nursing workforce already facing high levels of stress, burnout, and fatigue in the United Kingdom (UK) and internationally. The contribution of nurses to keeping the public safe was widely recognised as they met the challenges of delivering complex patient care during the healthcare crisis. However, the psychological impact of this on nurses' health and wellbeing has been substantial, and the number of nurses leaving the profession in the UK is rising. The aim of this study was to explore the experiences of nurses working during the COVID-19 pandemic and the impact of this on their psychological health, wellbeing and resilience. The study is part of a wider project to develop and pilot an online resilience intervention for nurses during COVID-19. Five focus groups with 22 nurses were carried out online. Data was analysed thematically using the Framework Method. Four key themes relating to positive and negative impacts of working during the pandemic were identified: Rapid changes and contexts in flux; loss and disruption; finding opportunities and positive transformation; and reinforcing and strengthening identity. Implications for coping and resilience in nursing, nursing identities and workforce development are discussed.

Exploring the effective elements on the personal and professional development among health-care providers: A qualitative study

BACKGROUND

A new domain of "personal and professional development" was introduced as a core competency of health-care providers. This study aimed to explore the experiences of learners and faculty members about what competencies or skills were essential for the professional development and success of health-care providers.

MATERIALS AND METHODS

This is a qualitative study using an inductive content analysis approach in 2019-2020. In the present study, 58 academic faculty members participated by purposeful sampling including ten associate professors (17.24%) and 24 assistance professors (41.37%), in addition to 23-year medical residents (20.65%) and 4^th-year nursing students (20.65%). Individual and group interviews were conducted. Data were analyzed by the inductive content analysis approach introduced by Graneheim and Lundman.

RESULTS

The qualitative data were classified in 953 open codes and eight categories, which were further divided into four main categories: "socio-emotional skills," "life-long learning skills," "coping skills," and "well-being strategies."

CONCLUSIONS

The present results showed socioemotional and coping skills affect interpersonal and professional interactions that contributed to their improved health-care providers' capabilities. Participants also considered lifelong learning as influential in developing professional capabilities and keeping their knowledge and skills up-to-date for accountability to duties. Moreover, using well-being strategies protects the mental and physical health of health-care providers. These skills are synergistic, and their combination can have a significant role in improving the personal and professional capabilities.

Experiences, Perceptions, and Coping Patterns of Emergency Department Nurses with Occupational Stressors in Saudi Arabian Hospitals: Mixed-Method Study

Extended working hours, a complicated workplace environment, and engagement in numerous physical and psychological stressors have been associated with the stressful nature of the nursing profession. Only a few studies have provided some insight into workplace stress and coping strategies adopted by nurses in Saudi Arabia and neighboring countries. Therefore, this study utilized a mixed-method design to explore the numerous factors that lead to stress among emergency nurses, their experience and perception of stress, and the coping mechanisms they find useful. A survey containing four domains and 86 items was adapted, pilot tested, and validated. The quantitative phase recruited 296 nurses who returned completed questionnaires, and then 21 nurses were interviewed for the qualitative phase. In total, 89.5% (n = 265) of the participants were female, 51% (n = 151) were aged 20–29 years, 83% (n = 246) were non-Saudi nationals, 49% (n = 145) were married, and 82% (n = 245) had a bachelor’s degree. The most common causes of occupational stress were work overload, personnel shortages, and inadequate pay. The qualitative phase data revealed five primary themes, including increased workload, rising living costs despite equal compensation, and staff shortages as main stressors. In addition, the study found that praying and spending quality time with friends are the primary coping techniques among nurses. The study results contribute to a better understanding of nurses’ working conditions in the emergency department. Additionally, they may contribute to the development of policies and practice reforms to improve Saudi nurses’ well-being, health, and overall work experience.

Coping With the Emotional Impact of Working in Cancer Care: The Importance of Team Working and Collective Processing

Hospitals provide the vast majority of cancer care. A necessary focus on survival has meant that they are less well-developed in terms of supporting patients with the emotional impact of cancer; and in supporting the frontline staff who contend with this. An integration of psychotherapeutic and neurobiological findings is used to develop an understanding of the patient-staff relationship and impact of high levels of distress within it. This includes reference to Transference and Countertransference, Mirror Neurons and Poly Vagal Theory. This paper considers how patients can unconsciously "transfer" emotional distress on to healthcare practitioners; and how this evokes an emotional response from the practitioner via the mirror neuron system (MNS). This can allow the practitioner to "feel into" the patient's experience and develop a more nuanced understanding. However, it may also activate emotions connected to the practitioner's life and can leave them feeling overwhelmed. The practitioner's capacity to regulate their own emotional arousal, via the vagus nerve, has a significant impact on their ability to support the patient and themselves within emotionally distressing interactions. This dynamic often unfolds without either party having significant awareness of it. A Systemic and Process-Oriented perspective is taken to understand this within the broader context of a hospital-based structure; and consider how practitioners on frontline teams may or may not support each other in working collectively with high levels of distress. A team's level of understanding and attunement to emotional experiences as well their primary relational and communication style has significant bearing on capacity for emotion-and-relationship focused coping. A failure to work with the emotional and relational interconnection between patients and staff can contribute to isolated patients, disconnected staff, conflict within teams and an overarching system lacking in compassion. However, due to the often unconscious nature of such processes and limited understanding or training on them, they are regularly left unaddressed. Over time, this can have an accumulated effect on everyone. Group-based collective processing is considered in terms of how it can be used in supporting practitioners to integrate an emotional and relational way of working with a problem-focused approach and integrated into regular daily working.

Development and psychometric evaluation of the emergency nurses' professional resilience tool

BACKGROUND

There is no specific tool for measuring the professional resilience of emergency nurses. Therefore, the present study aimed to design and psychometrically evaluate a new tool named the emergency nurses' professional resilience tool.

METHOD

This mixed-method sequential exploratory study was conducted in two phases: (1) item generation using literature review and evaluation of the results of a qualitative study and (2) psychometric evaluation of the developed scale. The face, content, and construct validity (exploratory and confirmatory factor analysis), reliability (internal consistency, relative, and absolute), and accountability were assessed in the population of Iranian nurses (N = 465) during March 2019-June 2020.

RESULTS

The tool designed for assessing the professional resilience of Iranian nurses included 37 items. The average scale content validity index (S-CVI/Ave) was equal to 0.94. The exploratory factor analysis revealed five factors, including professional competencies, emotional-cognitive characteristics, external support, in addition to behavioral and cognitive strategies, and explained 75.59% of the whole variance. Cronbach's alpha and intraclass correlation were 0.915 and 0.888, respectively. Construct validity for five factors was established with acceptable model fit indices [Chi-square/df = 1336.56/619, p < .001]; [Comparative Fit Index [CFI] = 0.96]; [Non-Normed Fit Index [NNFI] = 0.96]; [Root Mean Square Error of Approximation (RMSEA) = 0.074 and 90 Percent Confidence Interval = (0.069; 0.080)]; and [SRMR = 0.095].

CONCLUSIONS

According to the findings of the current study, the emergency nurses' professional resilience tool can be used by healthcare managers as a valid and reliable scale to evaluate the professional resilience of nurses to designate them as nurses working in emergency and disaster situations.

Lifestyle and Social Factors Exacerbated on the Prevalence of Mood Disorders and Functional Dyspepsia Among Neonatal Nurses in China

BACKGROUND

Nursing is a high-stress occupation that can have an impact on mental health, particularly for neonatal nurses. Job-related stress factors and work-related behaviors have played a critical role in nurses' mental health. This study aimed to explore the prevalence of mood disorders and the impact of social factors, lifestyle on mood disorders among neonatal nurses.

METHODS

A total of 260 participants comprising neonatal nurses and nurses who work in neonatal intensive care units (NICU) were recruited. Data were collected using a validated generalized anxiety disorder questionnaire, patient health questionnaire-9, Pittsburgh sleep quality index, and social factors and lifestyle assessments.

RESULTS

In total, 49.23% of neonatal nurses exhibited mood disorders, particularly a combination of depression and anxiety. Female, poor interpersonal relationships and unhappy marital status, preference for smoking, alcohol, irregular diet, and poor sleep were common in neonatology nurses who exhibited mood disorders; preference for coffee and tea were lower in neonatology nurses without mood disorders (all P < 0.05). Interpersonal relationships, marital status, irregular diet, and poor sleep were independent factors associated with mood disorders among neonatal nurses (all P < 0.05). Mood disorders presented as functional dyspepsia (FD) among 50.78% of the participants (P < 0.05). Poor sleep and preference for smoking were common among neonatal nurses who had FD with mood disorders (all P < 0.05). Furthermore, the preference for sugary beverages was lower in participants with FD and mood disorders (P < 0.05). Poor sleep was independently associated with FD with mood disorders in neonatology nurses (P < 0.05).

CONCLUSION

Prevalence of anxiety and depression was higher among neonatal nurses. Furthermore, most cases of mood disorders presented as FD. Thus, social factors and lifestyle have an impact on mood disorders which can manifest through somatic symptoms.

Chronic stress, behavioral tendencies, and determinants of health behaviors in nurses: a mixed-methods approach

BACKGROUND

Nurses experience high, and often chronic, levels of occupational stress. As high-quality care requires a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health behaviors in nurses with different stress levels and work-related behavioral tendencies and identified health behavior determinants based on the Health Action Process Approach (HAPA) model.

METHODS

Applying a mixed methods transformative triangulation design, n = 43 nurses filled out chronic stress (SSCS) and work-related behavior and experience patterns (German acronym AVEM) questionnaires, and participated in semi-structured interviews. With content analysis, categories of health behavior-related barriers and resources emerged. Behavior determinants (self-efficacy, outcome expectancies), health behavior, and barriers and resources were quantified via frequency and magnitude coding and interrelated with SSCS and AVEM scores to link level of health behavior with potential influencing factors. Nonparametric tests explored differences in quantified variables for SSCS and AVEM scores and 4-step-hierarchical regression analysis identified predictors for health behavior.

RESULTS

Eighty-four percent of the nurses were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) influenced health behaviors. Stress was associated with resource frequency (p = .027) and current health behaviors (p = .07). Self-efficacy significantly explained variance in health behaviors (p = .003).

CONCLUSION

Health promotion related barriers and resources should be considered in designing nurse health promotion campaigns. Practitioners need to individualize and tailor interventions toward stress and behavioral experiences for sustainable effects on adherence and health.

"This Isn't Just Busy, This is Scary": Stress, Social Support, and Coping Experiences of Frontline Nurses During the COVID-19 Pandemic

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations.

The relationship between neurocognitive performance and HRV parameters in nurses and non-healthcare participants

Nurses represent the largest sector of the healthcare workforce, and it is established that they are faced with ongoing physical and mental demands that leave many continuously stressed. In turn, this chronic stress may affect cardiac autonomic activity, which can be non-invasively evaluated using heart rate variability (HRV). The association between neurocognitive parameters during acute stress situations and HRV has not been previously explored in nurses compared to non-nurses and such, our study aimed to assess these differences. Neurocognitive data were obtained using the Mini-Mental State Examination and Cognistat psychometric questionnaires. ECG-derived HRV parameters were acquired during the Trier Social Stress Test. Between-group differences were found in domain-specific cognitive performance for the similarities (p = .03), and judgment (p = .002) domains and in the following HRV parameters: SDNN_baseline, (p = .004), LF_preparation (p = .002), SDNN_preparation (p = .002), HF_preparation (p = .02), and TP_preparation (p = .003). Negative correlations were found between HF power and domain-specific cognitive performance in nurses. In contrast, both negative and positive correlations were found between HRV and domain-specific cognitive performance in the non-nurse group. The current findings highlight the prospective use of autonomic HRV markers in relation to cognitive performance while building a relationship between autonomic dysfunction and cognition.

Intensive Care Unit Nurses' Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients

BACKGROUND

Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients. Few studies have reported types of work-related events that lead to occupational stress and post-traumatic stress disorder (PTSD).

METHODS

ICU nurses were recruited at an academic health science center to explore their experiences of caring for COVID-19 patients. Participants were interviewed for 1 hour using open-ended questions. Symptoms of PTSD were assessed using the PTSD Checklist, job satisfaction with a Likert-type scale, and intention to leave their job with a "yes or no" question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5.

FINDINGS

The ICU nurse sample comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed six recurring themes: Change in Practice, Emotion, Patient's Family, Isolation, Job Satisfaction, and Public Reaction. Quantitative findings revealed 7 of 10 met diagnostic criteria for PTSD. Most participants (7/10) were "somewhat satisfied" with their job. Five of 10 considered leaving their job in the last 6 months.

CONCLUSION/IMPLICATIONS FOR PRACTICE

Understanding the impact stressful pandemic-related patient care has on ICU nurses provides evidence that new policies are needed. Furthermore, qualitative findings provide insight into the best design and deployment of interventions to reduce stress and prevent development of PTSD. More research is needed to understand long-term effects of PTSD and to evaluate strategies to prevent PTSD during stressful emergency surges in intensive care.

The effect of medical material management system app on nursing workload and stress

Aims

To develop a clinical medical material management App for nurses, in order to reduce their workload and improve the efficacy of medical material management.

Design

The single-group pre- and post-test experimental design was adopted.

Methods

The subjects were nurses in the intensive care units of a regional hospital in Hsinchu City enrolled by purposive sampling. Single-group pre-tests and post-tests were conducted. The research period was from November 2019 to March 2020. The workload, stress, and information acceptance of 57 nurses before and after the intervention of the Medical Equipment App were collected. The research tools included a structured questionnaire, which includes open questions that cover the aspects of workload, stress, and information acceptance intention of nurses, as well as a demographic questionnaire, which collects the basic personal data, including gender, age, years of service, educational level, nursing ability level, use ability of IT products, and unit type. The results were analyzed and compared using SPSS, APP Inventor, and data mining modeling to determine the effects of the App.

Results

After employing the Shift Check App, the average workload of nurses was effectively reduced, in particular, the workload reduction of the N1 level nursing ability was greater than that of N2. In addition to satisfaction, the scores of information acceptance intention in all aspects, including behavioral intention, technology use intention, and contributing factors, all increased.

Conclusion

The use of information technology products to assist medical material management in clinical practice has a significant effect on the load reduction of nurses and improvement of satisfaction.

Clinical relevance

The App developed in this study can improve nurses’ work satisfaction, quality of care and workload reduction.

A Group Intervention to Promote Resilience in Nursing Professionals: A Randomised Controlled Trial

In this study, a new group intervention program to foster resilience in nursing professionals was tested for efficacy. In total, 72 nurses were recruited and randomised to either an intervention condition or to a wait list control condition. The study had a pre-test, post-test, follow-up design. The eight-week program targeted six resilience factors: cognitive flexibility, coping, self-efficacy, self-esteem, self-care, and mindfulness. Compared to the control group, the intervention group reported a significant improvement in the primary outcome mental health (measured with the General Health Questionnaire) from pre-test (M = 20.79; SD = 9.85) to post-test (M = 15.81; SD = 7.13) with an estimated medium effect size (p = 0.03, η² = 0.08) at post-test. Further significant improvements were found for resilience and other resilience related outcomes measures. The individual stressor load of the subjects was queried retrospectively in each measurement. Stress levels had a significant influence on mental health. The intervention effect was evident even though the stress level in both groups did not change significantly between the measurements. Follow-up data suggest that the effects were sustained for up to six months after intervention. The resilience intervention reduced mental burden in nurses and also positively affected several additional psychological outcomes.

Factors influencing hospital anxiety and depression among emergency department nurses during the COVID-19 pandemic: A multi-center cross-sectional study

INTRODUCTION

The emergency department (ED) is a highly stressful environment, which exposes nurses to infection. ED nurses handle life-threatening conditions, endure long working hours, and deal with anxious patients and their families.

AIM

This study aimed to examine factors, which may influence anxiety and depression levels among ED nurses during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional design was used with 251 participants from six hospitals in Saudi Arabia (mean age = 32.7 ± 6.59, range = 21-54 years, 70.5% females). Data were collected using the Hospital Anxiety and Depression Scale (HADS), and the analysis was conducted using structural equation modeling (SEM).

RESULTS

Based on the HADS scores, 29.1 and 25.5% of ED nurses were identified as doubtful cases for depression and anxiety, respectively. Additionally, 34.7 and 43.3% of ED nurses were identified as definite cases for depression and anxiety, respectively. Higher anxiety levels were observed among female nurses, nurses with lower physical activity levels, and nurses who worked in urban areas. Low physical activity levels and more than 6 years of work experience correlated with a higher level of depression. None of the hypothesized paths in the anxiety and depression models were significant, except for two observed variables-namely, work location and physical exercise in the anxiety model and physical exercise in the depression model.

CONCLUSION

Emergency department nurses expressed high levels of anxiety and depression during the COVID-19 pandemic, which may negatively affect their performance and reduce care quality. Therefore, health care leaders should implement specialized mental health education programs focused on nursing occupational safety and support to improve ED nurses' psychological well-being. Specific attention should be paid to ED female nurses who work in urban areas, especially those with more than 6 years of experience.

Impact of stress and coping strategies on insomnia among Polish novice nurses who are employed in their field while continuing their education: a cross-sectional study

OBJECTIVES

To determine to what degree particular coping strategies mediate the association between stress and insomnia in novice nurses who are employed while continuing their education and how type of education moderate the relationships between workplace stress, coping strategies and insomnia.

METHODS

A descriptive cross-sectional study was performed using an online questionnaire, which was completed by 159 novice registered nurses. The questionnaire comprised four components: Athens Insomnia Scale, Perceived Stress at Work (based on Perceived Stress Scale), Brief-Coping Orientation to Problem Experienced (COPE)and metrics with sociodemographic data questions.

RESULTS

Stress was found to be a significant predictor of insomnia among novice nurses. After adjusting the coping strategy, work stress ceased to be a significant predictor of insomnia. Among the strategies, the significant predictors that increased severity insomnia were acceptance, denial and self-blame. Predictors that decreased severity insomnia were use of emotional support and venting. Furthermore, the relationship between both active coping and self-distraction strategies and insomnia was significant for part-time students.

CONCLUSIONS

Insomnia is significant phenomena among novice nurses and are exacerbated by increased stress in the workplace. Choosing appropriate coping strategies for stress that are dependent on the individuals' activities significantly reduce the severity of insomnia caused by work stress.

Work-related factors predict changes in physical activity among nurses participating in a web-based worksite intervention: A randomized controlled trial

Background

Despite the numerous benefits associated with physical activity (PA), most nurses are not active enough and few interventions have been developed to promote PA among nurses. A secondary analysis of raw data from a single-centre, three-arm parallel-group randomized controlled trial was conducted to assess whether work-related characteristics and general mood states predict changes in total weekly moderate-to-vigorous intensity PA (MVPA) and average daily step-count among nurses participating in a 6-week web-based worksite intervention.

Methods

Seventy nurses (mean_age: 46.1 ± 11.2 years) were randomized to an individual-, friend-, or team-based PA challenge. Participants completed questionnaires pre- and post-intervention assessing work-related characteristics (i.e., shift schedule and length, number of hours worked per week, work role) and general mood states (i.e., tension, depression, anger, confusion, fatigue, vigour). Participants received a PA monitor to wear before and during the 6-week PA challenge, which was used to assess total weekly MVPA minutes and average daily step-count. Data were analyzed descriptively and using multilevel modeling for repeated measures.

Results

Change in total weekly MVPA minutes, but not change in average daily step-count, was predicted by shift schedule (rotating vs. fixed) by time (estimate = − 17.43, SE = 6.18, p = .006), and work role (clinical-only vs. other) by time (estimate = 18.98, SE = 6.51, p = .005). General mood states did not predict change in MVPA or change in average daily step-count.

Conclusions

Given that nurses who work rotating shifts and perform clinical work showed smaller improvements in MVPA, it may be necessary to consider work-related factors/barriers (e.g., time constraints, fatigue) and collaborate with nurses when designing and implementing MVPA interventions in the workplace.

Trial registration

ClinicalTrials.gov: NCT04524572. August 24, 2020. This trial was registered retrospectively. This study adheres to the CONSORT 2010 statement guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00739-4.

Multilevel Factors Affecting Healthcare Workers' Perceived Stress and Risk of Infection During COVID-19 Pandemic

Objectives: This study aimed to identify key factors affecting Healthcare workers (HCWs) perceived stress and risk of contracting COVID-19 among themselves and their family members during the pandemic. Methods: A cross-sectional online questionnaire study was conducted between 19 March and April 5, 2020 in Hong Kong. HCWs from public hospitals and private dentists, and their family members participated. Results: A total of 747 HCWs and 245 family members participated. Higher perceived stress in HCWs was associated with more negative changes in family relationship (p = 0.025). The HCWs' perceived stress, however, was positively associated with family cohesion (p = 0.033) and stress levels of family members (p < 0.001). The level of HCWs' satisfaction toward the hospital policies in response to the COVID-19 outbreak was associated with lower levels of perceived stress and risk of themselves or their family members contracting COVID-19. HCWs' previous frontline experience of SARS was significantly associated with less perceived risk of themselves or their family members contracting COVID-19. Conclusion: Hospital policies addressing HCWs' needs, frontline experience of SARS, and family relationship influenced psychological wellbeing of HCWs during the COVID-19 outbreak.

Gender Gap in Mindfulness Assessment Among Italian Nurses: A Pilot Descriptive Study

"Purpose: The present study aimed to explore gender differences in the mindfulness tendency, specifically in the awareness and attention dimensions and also in the observing, describing, acting with awareness and accepting without judgement in Italian nurses. Methods: In June 2020 an on-line questionnaire was administered to nurses in order to analyze any differences both in the Mindfulness Attention Awareness Scale (MAAS) and the Kentucky Inventory of Mindfulness Skills (KIMS) according to gender variable. Findings: 200 questionnaires were collected. Findings showed significant higher MAAS total score in males than females (p=.004). Additionally, by considering the four sub dimensions in the Mindfulness tendency, females reported significant higher levels in some items of “Observe” (p=.004) and “Act with awareness” (p=.001) than males, while males reported significant higher scores in the “Accept without judgement” than females (p<.001). Conclusions: The present study was a pilot research on exploring gender differences in mindfulness in Italian nurses in order to hope that it will be only the beginning of empirical research on this topic and to better address future mindfulness training courses addressed to nurses by emphasizing certain aspects of mindfulness for females compared to males and vice versa."

Effects of health-promoting leadership, employee health on employee engagement: employability as moderating variable

Purpose

Employee health is a major challenge for enterprises. Fostering a healthy work environment and promoting employee engagement are key to addressing this challenge. Health-promoting leadership and employee health are the driving forces of corporate development; at the same time, employability is the core element of employee relations. Based on self-determination theory, this study aims to explore the effects of health-promoting leadership and employee health on employee engagement in light of employee employability.

Design/methodology/approach

The data of this study encompass 723 valid questionnaires from employees of MSME in China. This study focuses on health-promoting leadership and employee health, engagement relationship and the above relationship moderating by employability.

Findings

Health-promoting leadership plays a key role in the workplace, results show that health-promoting leadership has a positive impact on employee health and employee engagement, while employee health did not have a positive effect on employee engagement. Employability negatively moderated the relationship between employee health and employee engagement.

Research limitations/implications

This study is based on cross-sectional survey data collected at the COVID-19 pandemic. The pandemic rapidly and continuously changed the organizational responses to employee health. Future studies could utilize longitudinal methods or focus on measurement instruments of the culture of health, to create additional insights about health promoting.

Originality/value

This study adds important knowledge regarding health-promoting leadership and employee health in Chinese MSMEs, an area for which limited research exists. The findings provide insights and knowledge about health-promoting leadership how to affect employee health and to improve engagement outcomes. The findings also identify the moderating role of employability.

Sources of Stress and Coping Strategies Among Undergraduate Nursing Students Across All Years

Background

Undergraduate nursing students experience high levels of stress during their programs. The literature on their stress is extensive, however, what is less well-known are the specific sources of stresses for students in different years of study.

Purpose

The aim of this study is to understand nursing students’ sources of stress and coping strategies in each year of study.

Method

A transversal descriptive qualitative study was used. A sample of 26 undergraduate students attending a university in Montreal, Canada were recruited and participated in a semi-structured interview. Data were analysed using inductive thematic analysis.

Results

The sources of stress differed according to year of study and related significantly to the specific novelty of that year. For first-year students, their stress was related to their academic courses. High clinical performance expectations and a lack of time for their personal lives was a main source of stress for second-year students. The prospect of graduating and transitioning into the work environment caused stress for students in their final year. Students across all years of study utilized similar coping strategies.

Conclusion

The findings suggest that interventions can be developed to address the sources of stress experienced by nursing students in each year of study.

Sense of coherence and strategies for coping with stress among nurses

BACKGROUND

The nursing profession is associated with constant presence of difficult situations and stress, which arise from responsibility for the highest values - human life and health. With demographic changes in the society, the demand for nursing care increases. Looking after the health of nursing staff becomes a non-material investment in employees. One of the most important health potentials described in literature is the sense of coherence. It can significantly contribute to maintaining good health, modify one's functioning in a stressful working environment and influence the choice of strategies for coping with stress.

AIM

The aim of the study was to describe the specific relationship between the sense of coherence and strategies for coping with stress in a group of professionally active nurses.

METHODOLOGY AND METHODS

The study involved 91 nurses in central Poland, aged 22-52. The group was diversified in terms of: education, work system, marital status and place of residence. The study was conducted with the use of: Sense of Coherence Questionnaire SOC-29 and Inventory to Measure Coping Strategies with Stress - Mini-COPE. The study was conducted in accordance with the principles of scientific research set out in the Helsinki Declaration.

RESULTS

The sense of coherence value in the test group was M = 134.24 (SD = 19.55). In stressful situations nurses most often used active strategies to cope with stress: Planning M = 2.10 (SD = 0.54), Seeking Emotional Social Support M = 1.95 (SD = 0.68) and Seeking Instrumental Social Support M = 1.95 (SD = 0.69), and the least frequently: Alcohol/Drug Use M = 0.28 (SD = 0.48). The level of the sense of coherence and its components differentiated the strategies of coping with stress used in the examined group of nurses.

CONCLUSIONS

The research confirmed that the sense of coherence serves as a health potential in a stressful working environment - a high sense of coherence translate into better mental health, correct functioning in the working environment, and using adaptive strategies of coping with stress. Nurses with a stronger sense of coherence used more adaptive strategies to deal with stress than those with average or low levels.

Prevalence and predictors of burnout and work-life balance within the haematology cancer nursing workforce

PURPOSE

The effects of burnout can have serious consequence for individual nurse's, patients and healthcare organisations. The aim of this study was to assess prevalence and predictors of burnout and work-life balance amongst haemato-oncology nurses.

METHODS

This study employed a cross-sectional survey design. Haematology cancer nurses attending a 2-day conference in Ireland, during Oct 2019 were recruited. Anonymised data were collected on: 1) socio-demographics and occupational variables, 2) burnout using Maslach Burnout Inventory and 3) satisfaction with work-life balance.

RESULTS

There was an 80.4% survey completion rate (n = 78 of 97). One-third of haemato-oncology nurses reported high levels of emotional exhaustion, with an additional 46% experiencing moderate levels. Despite this, 64% of nurses highlighted a moderate or high level of personal accomplishment. Demographics such as <40yrs old, unmarried, working ≥25hrs per week and having 6-10 years' experience in haemato-oncology, all showed trends towards increased burnout, although none reached statistical significance. Over half (58%) surveyed were dissatisfied with their work-life balance. Nurses with dependent children had statistically significant poorer work-life balance scores. In addition, one-third reported they did not receive adequate support or reasonable adjustments from their organisation, with inpatient nurses finding this particularly challenging.

RELEVANCE TO CLINICAL PRACTICE

Taking into consideration the high levels of burnout, healthcare organisations should have a responsibility to teach approaches of stress management, self-care and foster resilience within their workforce. Oncology nurses with dependent children, working in in-patient settings, have identified a need for greater flexibility with working conditions, to improve work-life balance.

The role of psychological variables in improving resilience: Comparison of an online intervention with a face-to-face intervention. A randomised controlled clinical trial in students of health sciences

BACKGROUND

Most studies on improving resilience lack representative samples and pre- and post-intervention assessments. Results regarding the effectiveness of online interventions versus face-to-face interventions are mixed.

OBJECTIVES

To evaluate the effectiveness of online and face-to-face programmes for the improvement of coping strategies to develop resilience to stressful situations, and to assess their relationship with personality traits, mood, and academic stressors.

DESIGN

Randomised controlled clinical trial. Three-armed parallel design.

PARTICIPANTS

245 students of the Nursing and Physical Therapy Degree.

METHODS

Students were randomly assigned to the control group (CG), intervention group 1 (IG-1, face-to-face) or intervention group 2 (IG-2, online). They were assessed after the intervention with the following instruments: the Positive and Negative Affect Schedule (PANAS), the Academic Stressors Scale, the Coping Orientation to Problems Experienced (COPE), the Connor-Davidson Resilience Scale, and the NEO-FFI scale.

RESULTS

Negative affect was higher in IG-1 (p = 0.12). The greatest stressors were methodological deficiencies of the teaching staff, academic overload, and beliefs about academic performance. The most widely used coping strategies were "Active Problem-Focused Coping" and "Seeking Social Support". There were differences between IG-1 and IG-2 only regarding "Focus on and Venting of Emotions" (p = 0.086). On the Resilience scale, "Persistence, Tenacity, and Self-Efficacy" was higher in the CG, and there were differences with IG-1 (p = 0.06). With respect to the traits measured by the NEO-FFI questionnaire, higher levels of emotional instability (neuroticism) were observed in IG-1 than in the CG (p = 0.06).

CONCLUSIONS

The results of both interventions are similar, with increased self-awareness of negative personality traits, which is useful for those ignoring their areas for improvement. In addition, these factors are further increased in individuals with high levels of neuroticism and low levels of extraversion. The online intervention was as effective as the face-to-face intervention.

Nurse Stress Scale (NSS): Reliability and validity of the Turkish version

PURPOSE

This study aims to conduct the reliability and validity study of the Turkish version of the Nurse Stress Scale (NSS), which determines the job stress of nurses.

DESIGN AND METHODS

The sample of the methodological study consisted of 349 nurses.

RESULTS

The factor load of the scale was in the appropriate range (0.32-0.79), Cronbach's α was determined as .928, and the item total score correlations ranged between 0.418 and 0.662. The test-retest reliability coefficient was determined to be r = .859.

PRACTICE IMPLICATIONS

The Turkish version of the NSS was evaluated and it was found that it could be used as a valid and reliable measurement tool in Turkish nurses. Health care service providers can use NSS to determine the work stress of nurses.

Coping with Stress Among Israeli-Palestinian High School Students: The Role of Self-Control, Religiosity, and Attachment Pattern

Israeli-Palestinian adolescents living in Israel may have a unique set of stressors, given the societal tension between Israeli and Palestinian practices that may influence youths' identities (e.g., modernization, gender roles). However, little research has examined risk factors that may undermine one's ability to cope with stress effectively within this population. Thus, the current study examined the role of religiosity, self-control skills and emotional attachment style as risk factors for less effective (more passive, fewer active strategies) coping with stressful situations. Participants (n  = 487) were recruited from seven junior high schools located in the Northern Triangle region of Israel. Consistent with hypotheses, poorer self-control skills, and anxious and avoidant emotional attachment style were each associated with a greater likelihood to engage in passive coping skills. In addition to positive correlation between religiosity and active coping skills in response to stressful situations, these findings parallel prior studies that have examined broader demographic samples, suggesting the cross-cultural relevance of these risk factors for effective coping with stress.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.

Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.

Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.

Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

[Personal Resources of Geriatric Nursing Staff - Results of a Cross-Sectional Study]

OBJECTIVES

Geriatric nursing staff are exposed to high workloads, which often lead to stress, incapacity to work and early retirement. Personal resources can help deal with work demands and can have a positive effect on health. To design tailored interventions, this study aims to identify personal resources of staff and its impact on stress levels.

MEASURES

Data on 195 geriatric nurses (87.4% female, 40.1±12.2 years) were collected using a set of validated questionnaires consisting of Slesina questionnaire, Nordic Questionnaire, SF-12, personal resources (according to WHO criteria), AVEM questionnaire and the SSCS scale of the TICS questionnaire. According to the SSCS scale, nursing staff were divided into stressed and non-stressed. To further investigate potential factors influencing the development of stress, a four-step regression analysis was carried out.

RESULTS

Non-stressed geriatric nursing staff felt less burdened by work-related stress factors, had fewer physical complaints, had higher physical (p<0.001) and mental well-being (p <0.001), better personal resources and healthier work-related behavior and experience. The regression analysis showed that personal resources such as satisfaction with health status, nutritional behavior, frequency of being calm and relaxed, frequency of being full of energy as well as the stress level can improve physical and mental well-being, but cannot decrease the emergence of stress in case of unhealthy work coping behavior (R²=0.760).

CONCLUSION

When developing stress prevention interventions, the focus should be on strengthening personal resources. In addition, individual work-related behavior and experience patterns should be taken into account.

Nurses' physical activity exploratory study: Caring for you so you can care for others

BACKGROUND

Nurses report the greatest stress of all health care workers. Although physical activity (PA) is associated with health benefits among other populations, nurses have stressors that other occupations do not typically encounter. It is important for nurses to identify techniques for stress management since stressors negatively impact their health and patient care.

OBJECTIVE

We aimed to examine the relationship between PA levels and physical, mental, and occupational health among nurses.

METHODS

Nurses (N = 62) completed measures of anthropometrics, demographics, and domains of physical, mental, and occupational health. Pearson correlations determined the relationship between PA and measures health along with the relationship between PA and health among active versus inactive nurses.

RESULTS

Fatigue was significantly correlated with moderate-to-vigorous PA (r = -0.27, p < 0.05). Relationships were found between mental health and light and moderate intensity PA (r = 0.40, p < 0.001; r = 0.30, p < 0.05).

CONCLUSIONS

Stress is prevalent among nurses and negatively impacts a nurse's health along with patient care. Findings suggest health benefits associated with PA among nurses. PA interventions among nurses may be needed to fully see the effects of PA on physical, mental, and occupational health, and ultimately patient health and safety.