Development of a stress scale for mental health professionals

Factors affecting the caring performance of newly graduated Nurses' working in critical care units

BACKGROUND

Although many studies have discussed nurses' caring performance, few have focussed on critical care nurses. Also, none have studied this among newly graduated nurses despite their very different circumstances.

AIM

The purpose of this study was to examine factors affecting the caring performance of newly graduated nurses in critical care units.

METHOD

A descriptive cross-sectional design, using self-reported questionnaires, was used among a sample of 209 nurses interviewed in Jordanian hospitals. The Mental Health Professionals Stress Scale was used for measuring work-related stress and the Caring Behaviours Assessment tool to assess caring performance. Data collection was conducted from March to May 2018.

RESULTS

The participants had moderate levels of caring performance (M = 182.6/315, SD = 15.46). The highest score was reported for 'Supportive/Protective/Corrective Environment' subscale, while the lowest for 'Teaching/Learning' subscale. Many significant differences were noticed in caring performance based on participants' demographics. Only working in private hospitals was a significant predictor for caring performance (P < .05) predicting 14% of variance.

CONCLUSION

Caring performance of newly graduated nurses in critical care units was affected by many factors including workload, self-doubt, income and area of working. The significance was flagged of developing nursing policies concerned with stress relief and improvement of caring performance.

Assessment of Stress Salivary Markers, Perceived Stress, and Shift Work in a Cohort of Fishermen: A Preliminary Work

Due to work-related stress, today, work itself represents a daily challenge that must be faced in many occupations. While, in the past, the scientific community has focused on the helping professions, since, an increasing number of professions have since been investigated. Therefore, different approaches exist in order to assess this disorder, representing a scientific field wherein biological and psychological dimensions both need to be evaluated. In this paper, we consider three biological salivary markers: interleukin 1 beta (IL-1β), cortisol, and melatonin. The choice derives from recent contributions to the literature in which the interplay between these markers has been verified. Briefly, such interplay could explain how the central nervous, endocrine, and immune systems communicate with each other, supporting a holistic concept of person. In 30 marine fishermen from the Apulia region of Italy, perceived stress was measured using the Professional Stress Scale (PSS) and sleep disturbances were assessed through the Pittsburgh Sleep Quality Index (PSQI). Salivary markers were collected at 8:00 a.m. and 2:00 p.m. Those subjects reporting sleep disturbance and having altered scores in two PSS subclasses, home-work conflict and self-esteem, presented inverted salivary melatonin and cortisol nictemeral rhythms (with regard to melatonin levels at 8:00 a.m., those workers reporting values higher than the median showed 64.1% versus 48.6% home-work conflict with respect to cortisol levels, subjects having an inverted circadian rhythm showed 69.9% versus 52.5% home-work conflict, and these values resulted 47.7% versus 25.3% when the self-esteem was considered). As regards melatonin, PSQI score is statistically different in the two groups of subjects as identified by median melatonin at 8:00 a.m.; specifically, the subjects who had mean values higher than the median shared higher PSQI scores (10.8 versus 9.8). The same subjects reported more frequent home-work conflict and more sleep disorders. We found a negative correlation between IL-1β at 8:00 a.m. and Cortdiff (the difference between cortisol at 8:00 a.m.-cortisol at 2:00 p.m.), and that high IL-1β at 8:00 a.m. was associated with low Cortdiff. Based on our results we would like to propose this approach in health surveillance, in order to prevent mental and/or physical disorders, however our study is surely preliminary. The interesting perspectives and hypotheses cited in this paper, in which the roles of IL-1β and norepinephrine appear central and important, could remain hypothetical if not supported by more robust observation in order to produce, truly, new knowledge. In the future we will deepen this study with a larger sample, and if these results will be confirmed, this approach could allow preventing, not only mental and physical disorders, but also immuno-mediated diseases, and, perhaps, cancer.

Empowerment Predicting Nurses' Work Motivation and Occupational Mental Health

INTRODUCTION

Empowering nurses is essential for improving work outcomes, and understanding the role of structural and psychological empowerment in supporting nurses' work motivation and occupational mental health are essential to stimulate nurses' productivity and preserve their mental health.

OBJECTIVES

To evaluate nurses' perspectives about the levels of structural and psychological empowerment in their working areas. Additionally, to evaluate nurses' motivation and occupational mental health, and to predict the nurses' motivation and occupational mental health through structural and psychological empowerment.

METHODS

A descriptive correlational design and quota sampling were used. Two hundred registered nurses were recruited from two hospitals in Jordan. Data were collected using four valid and reliable self-report questionnaires.

RESULTS

Nurses who participated in this study were young and have an average total experience in nursing of fewer than 10 years. Nurses in this study reported a moderate level of structure empowerment and a low level of psychological empowerment. Significant positive relationships were documented between both structural, psychological empowerment, and nurses' work motivation (r = 0.85), (r = 0.83) respectively. A significant negative relationship found between both structural, psychological empowerment, and nurses' occupational mental health (r = -0.31), (r = -0.29) respectively.

CONCLUSIONS

The levels of nurses' work motivation and occupational mental health can be predicted through the levels of structural and psychological empowerment. The higher workplace empowerment was associated with increased work motivation, as well as reduced the feeling of occupational stress among nurses. Thus, administrators should invest in fostering structural and psychological empowerment in the work environment.

Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals: A Repeated-Measures Observational Study

BACKGROUND

Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress.

PURPOSE

To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]).

METHODS

The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center.

RESULTS

No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed.

IMPLICATIONS FOR PRACTICE

NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals.

IMPLICATIONS FOR RESEARCH

The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.

Psychometric Properties of the Korean Version of the Mental Health Professionals Stress Scale

Background: Job stress of mental health professionals can have a negative impact on them, particularly their psychological health and mortality, and may also affect organizations' and institutions' ability to provide quality mental health services to patients. Aim: This study aimed to: (1) investigate the validity and reliability of the Korean Mental Health Professionals Stress Scale (K-MHPSS), (2) develop K-MHPSS cut-off points to measure clinical depression and anxiety, and (3) examine whether specific stressors vary by area of expertise. Methodology: Data were collected via an online survey over 3 months, from August to October 2020. An online survey using a survey website was administered to volunteers who accessed the link and consented to participate. Data from 558 participants (200 clinical psychologists, 157 nurses, and 201 social workers) were included in the final analysis. Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the K-MHPSS; concurrent validity of the scale was determined by analyzing correlation; internal consistency was determined by Cronbach's alpha coefficient. In addition, ROC curve analysis and Youden's index were used to estimate optimal cut-off points for K-MHPSS; one-way ANOVA was performed to investigate the difference among the three groups. Results: The seven-factor model of the original scale did not be replicated by Korean mental health professionals. The K-MHPSS had the best fit with the six-factor model, which consists of 34 items. Concurrent validity was confirmed, and overall reliability was found to be good. The K-MHPSS cut-off points for depression and anxiety appeared to slightly different by professional groups. Furthermore, nurses and social workers showed significantly higher total scores compared to clinical psychologists, and there are significant differences in subscale scores among professionals. Conclusion: The Korean version of the MHPSS has appropriate psychometric properties and can be used to assess the occupational stress of mental health professionals. It can also serve as a reference point for screening clinical level of depression and anxiety in mental health professionals.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Effectiveness of interventions to reduce occupational stress among emergency department staff: a systematic review protocol

REVIEW QUESTION

The aim of the review is to synthesize the best available evidence on interventions targeting occupational stress and burnout among emergency department (ED) staff. The specific review questions are.

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.

Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme

Background

Despite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.

Objectives

To understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.

Design

The programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.

Main outcome measures

The main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.

Results

We developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).

Strengths and limitations

We have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.

Future work

Our database will be used to develop an understanding of the mediating and moderating factors for improving care quality.

Trial registration

Current Controlled Trials ISRCTN06545047.

Funding

This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.

Development of a Self Report Stress Scale Using Item Response Theory-I: Item Selection, Formation of Factor Structure and Examination of Its Psychometric Properties

INTRODUCTION

Due to the absence of Turkish psychometric devices assessing stress, in the present study it was aimed to develop a stress scale, and examine its basic psychometric properties.

METHODS

Current study included two processes, formation of item pool and examination of psychometric properties of the selected items through three studies. In the first study, 611 individuals aged between 18 and 77 responded to 130 selected items. In the second study, 2223 individuals aged between 18 and 68 responded to 80 items. In the third study, 1969 individuals aged between 18 and 79 responded to the final form of 36 items. Further, in study 3 for criterion related validity 163 individuals completed the Coopersmith Self-Esteem Inventory, 113 individuals completed the Beck Anxiety Inventory, 104 individuals completed the Hospital Anxiety and Depression Scale, 107 individuals completed the Beck Depression Inventory, and 265 individuals completed the Perceived Stress Scale. Moreover, in the investigation of test-retest reliability, 119 individuals took the final form of the test after 2 weeks, and 111 individuals took the final form of the test after 3 weeks.

RESULTS

In the first study, out of 130 items, 54 that showed item-total score correlations below 0.30 were excluded from the scale. Fifty-seven items were preserved exactly, and 19 items' sentence structures were changed. Furthermore, by adding 4 new items, 80 were prepared for the second study. In the second study, two factors structure namely "Physiological Reactions/Strain" and "Psychological/Cognitive Appraisals" sub-dimensions were identified, and 36 items were selected via Item Response Theory representing these sub-dimensions. In study 3, exploratory factor analysis provided strong support for our hypothesized two factors structure. Confirmatory factor analysis indicated hypothesized model had a better fit to the data. Internal consistency coefficients were 0.94 for the entire scale, 0.90 for Physiological Reactions/Strain sub-dimension, and 0.91 for Psychological/Cognitive Appraisals sub-dimension. Correlation coefficients between the entire scale and other criterion scales ranged from 0.22 to 0.63. Test-retest correlation coefficients between the first administration of the scale, and the administrations at two and three week intervals were 0.88.

CONCLUSION

Results showed that the scale has basic psychometric requirements provided that the scale will be supported by validity studies.

How Effective are Mindfulness-Based Interventions for Reducing Stress Among Healthcare Professionals? A Systematic Review and Meta-Analysis

Workplace stress is high among healthcare professionals (HCPs) and is associated with reduced psychological health, quality of care and patient satisfaction. This systematic review and meta-analysis reviews evidence on the effectiveness of mindfulness-based interventions (MBIs) for reducing stress in HCPs. A systematic literature search was conducted. Papers were screened for suitability using inclusion criteria and nine papers were subjected to review and quality assessment. Seven papers, for which full statistical findings could be obtained, were also subjected to meta-analysis. Results of the meta-analysis suggest that MBIs have the potential to significantly improve stress among HCPs; however, there was evidence of a file drawer problem. The quality of the studies was high in relation to the clarity of aims, data collection and analysis, but weaker in terms of sample size and the use of theoretical frameworks. MBIs have the potential to reduce stress among HCPs; however, more high-quality research is needed before this finding can be confirmed. Future studies would benefit from long-term follow-up measures to determine any continuing effects of mindfulness training on stress outcomes. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of emotional exhaustion, disengagement and burnout among improving access to psychological therapies (IAPT) practitioners

BACKGROUND

Among mental health staff, burnout has been associated with undesirable outcomes, such as physical and mental ill-health, high levels of staff turnover and poorer patient care.

AIMS

To estimate the prevalence and predictors of burnout amongst Improving Access to Psychological Therapist (IAPT) practitioners.

METHODS

IAPT practitioners (N = 201) completed an on-line survey measuring time spent per week on different types of work related activity. These were investigated as predictors of burnout (measured using the Oldenburg Burnout Inventory).

RESULTS

The prevalence of burnout was 68.6% (95% confidence interval (CI) 58.8-77.3%) among psychological wellbeing practitioners (PWP) and 50.0% (95% CI 39.6-60.4%) among high intensity (HI) therapists. Among PWPs hours of overtime-predicted higher odds of burnout and hours of clinical supervision predicted lower odds of burnout. The odds of burnout increased with telephone hours of patient contact among PWPs who had worked in the service for two or more years. None of the job characteristics significantly predicted burnout among HI therapists.

CONCLUSIONS

Our results suggest a high prevalence of burnout among IAPT practitioners. Strategies to reduce burnout among PWPs involving reductions in workload, particularly telephone contact and increases in clinical supervision need to be evaluated.

Is Discrepancy between Actual and Preferred Work Activities a Factor in Work-Related Stress for Mental Health Occupational Therapists and Social Workers?

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress.

A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively.

Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.

Development and Initial Validation of the Stress of Conscience Questionnaire

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

Emotional Stress and Coping Strategies in South African Clinical and Counselling Psychologists

This study aimed to explore psychologists' emotional stress levels, as manifested in anxiety and depression, their coping strategies, and the relationship between stress and coping strategies. A stratified random sample of 238 South African clinical and counselling psychologists completed internet surveys that included a biographical questionnaire, the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and the Brief Coping Orientations to Problems Experienced (Brief COPE). According to category cut-off points in the manuals, results indicated that 56.3% of participants reported above average anxiety levels, while 54.2% were mildly depressed. A combination of the coping strategies of self-blame, behavioural disengagement, denial, a lack of humour, self-distraction, a lack of acceptance, venting, and substance use significantly predicted anxiety. A combination of substance use, self-blame, self-distraction, denial, and a lack of seeking instrumental support significantly predicted depression. The results suggest that South African psychologists fail to manage their emotional stress as manifested in depressive and anxiety symptoms. A coping programme for South African psychologists in practice and training is recommended. In addition, psychologists are encouraged to nurture their emotional health through psychotherapy and support groups. The limitations of sampling in terms of possible psychological sophistication and self-selection, as well as the need to further differentiate the work settings of psychologists, are discussed.

Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region

Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions aimed at increasing personal accomplishment be implemented for both groups of nurses. An investigation of perceived job control and the use of social support would also be insightful.

Effects of Acceptance and Commitment Therapy (ACT) Training on Clinical Psychology Trainee Stress, Therapist Skills and Attributes, and ACT Processes

Despite the increasing uptake of Acceptance and Commitment Therapy (ACT) by mental health practitioners, few studies have investigated the effects of ACT training on trainees. Clinical psychology trainees (CPTs) are susceptible to high stress such that their training represents a teachable moment for personal application of the therapy skills they learn for clinical practice. This study investigates the effects of ACT training on stress, therapist skills and attributes, and the personal acquisition of ACT strategies in CPTs. Thirty-two CPTs completed questionnaires before and after university-based ACT training that consisted of 12 2-h weekly workshops. Pairwise t-tests showed that CPTs reported improvements from before to after training on measures of counselling self-efficacy, client-therapist alliance, self-kindness, acceptance, defusion, mindfulness and values, and a marginally significant improvement on somatic symptoms, despite a trend towards increased work-related stress. As predicted, each of the ACT process variables was related to one or more of the therapist stress, skill and attribute variables, such that greater levels of mindfulness, values and acceptance, and less thought suppression were related to better trainee outcomes. This study provides preliminary data on therapist skill development and personal benefits for CPTs related to receiving ACT training that interweaves instruction in competencies acquisition with self-care.

KEY PRACTITIONER MESSAGE

This study provides preliminary data on therapist skill development and personal benefits for clinical psychology trainees related to receiving ACT training that integrates training in competencies acquisition with self-care. The ACT training offers a framework for integrating the acquisition of clinical competencies and self-care skills and positive therapist attributes in trainees. Findings support a strong positive union between the ACT processes and better trainee personal and professional outcomes.

Views of the Therapeutic Environment (VOTE): stakeholder involvement in measuring staff perceptions of acute in-patient care

BACKGROUND

The impact of staff perceptions of daily work pressures on burnout requires further exploration because both issues may be adversely affecting the quality of staff interactions with service users.

OBJECTIVES

To use a model of 'stakeholder involvement' to develop and test a self-report instrument capturing nursing staff perceptions of the daily pressures of working in acute in-patient mental health wards.

DESIGN

Measure development followed a participatory methodology, followed by psychometric testing of the new measure of the daily pressures of working on an acute ward (VOTE).

SETTINGS

Acute in-patient wards in an inner London mental health trust.

PARTICIPANTS

All nursing staff from acute in-patient settings are eligible for this study. In total 376 staff (qualified nurses and healthcare assistants) were involved at the various stages of measure development and testing.

METHODS

Focus groups of nursing staff met to discuss their perceptions of acute wards. A twenty item measure was generated through thematic analysis of these data and staff feedback. Reliability and validity were tested and the effects of demographic characteristics on VOTE, and VOTE on burnout were examined.

RESULTS

Staff found VOTE easy to understand and complete. Test-retest reliability and the internal consistency of the measure and subscales were good. A test of criterion validity showed that staff with negative perceptions of the daily pressures of the working on an acute ward also had negative perceptions of job satisfaction and high levels of burnout. Regression modelling showed that VOTE had a significant effect on burnout.

CONCLUSIONS

VOTE is a concise measure which combines aspects of care provision as well as the organisational and professional stressors of acute ward working. VOTE can be used to further explore how staff perceptions of the daily pressures of acute ward working affect the quality of care delivered.

The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit

PURPOSE

The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes.

DESIGN AND METHODS

A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used.

FINDINGS

The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care.

PRACTICE IMPLICATIONS

Increases in patient satisfaction and decreases in patient safety events were found.

The effectiveness of an ACT informed intervention for managing stress and improving therapist qualities in clinical psychology trainees

OBJECTIVES

Clinical psychology trainees (CPTs) are vulnerable to high stress, which can adversely affect their personal and professional functioning. This study evaluated the effectiveness of a group acceptance and commitment therapy (ACT) informed stress management intervention for CPTs.

DESIGN

Outcome measures were work-related stress, distress, life satisfaction, counseling self-efficacy, self-compassion, and therapeutic alliance. A cohort-controlled design, where an experimental group (n = 28) was compared with a waitlist control group (n = 28), was utilized, with a 10-week follow-up.

RESULTS

Group comparisons showed statistically significant intervention effects for the main outcome measures, which were maintained at follow-up. Mediational analyses showed that changes on most outcomes were mediated by ACT mindfulness and acceptance processes.

CONCLUSIONS

Findings support the effectiveness of a group ACT program for CPTs regarding stress reduction and improving therapist qualities.

Stressor Scale for Clinical Research Coordinators: development and psychometric testing

AIM

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Revalidation of the Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.

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

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

Mental health nursing in Jordan: an investigation into experience, work stress and organizational support

Changes in mental health services have an impact on the role and practice of mental health nurses. The purpose of this study was to examine Jordanian mental health nurses' experiences of providing mental health care, their work-related stress, and organizational support received. A descriptive correlation design was used. Data were collected using self-report questionnaires from 92 mental health nurses in Jordan. The result of this study revealed that mental health nurses shared a high level of agreement on the importance of most nursing tasks. Mental health nurses reported a moderate level of stress, with a lack of resources and relationship and conflict with other professionals being the most frequent stressors. Nurses perceived a low level of support for their work from their supervisors. Work stress and conflict with other professionals had a significant, negative correlation with the perception the nurses had of their immediate supervisors (r = -0.29, P < 0.001; r = -0.31, P < 0.001). There was no significant correlation between work stress, organizational support, and the nurses' age, sex, or level of education. This study has clinical implications in terms of developing strategies for reducing stress and improving organizational support among mental health nurses, and it should help in future research.

Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND

Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.

METHODS

A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).

RESULTS

(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.

CONCLUSION

The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).

The relationship between professional identity and burnout among occupational therapists

ABSTRACT Health professionals have been identified as a high risk group for job-related stress and burnout. This study builds on the existing literature to examine the links between burnout and the development of professional values as well as the broad scope of occupational therapy, which may act as a hindrance to establishing a concise and well recognized professional identity. One hundred and twenty six occupational therapists completed the Maslach Burnout Inventory and the Professional Identity Questionnaire. The factors that contribute to the relationship between a lack of professional identity in the field of occupational therapy and the levels of burnout among occupational therapists are identified and implications for establishing a strong and healthy workforce in occupational therapy are discussed.

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers

OBJECTIVE

In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services.

METHOD

A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy.

RESULTS

The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring.

CONCLUSION

Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Compassion fatigue and the adult protective services social worker

Compassion fatigue is a relatively new term that describes the symptoms that are experienced by social workers and other helping professionals who work with clients experiencing trauma. This article defines the concept of compassion fatigue and relates compassion fatigue to Adult Protective Services (APS) social workers. It is proposed that APS social workers may be susceptible to the deleterious effects of compassion fatigue due to the nature of their work and environment. Suggestions for avoidance of compassion fatigue are also discussed, including self-care strategies and the need for continuing education regarding this phenomenon.

Open-Bay and Single-Family Room Neonatal Intensive Care Units

The purpose of this study is to explore the implications of neonatal intensive care unit (NICU) single-family rooms (SFRs) relative to open-bay arrangements. A recent trend in the design of NICUs has been to increase the number of private patient rooms for neonates and their families. Several factors have contributed to the popularity of SFRs, including compliance with the Health Insurance Portability and Accountability Act, which mandates the need to provide patient privacy. Surveys of NICU medical staff ( N = 75) explored the preferences and experiences of individuals providing care in two facilities, an SFR NICU and a combination unit with open-bay infant stations and SFRs. The results of this study indicate that SFR NICU design may increase staff satisfaction and reduce staff stress.

Sources of stress and burnout in acute psychiatric care: inpatient vs. community staff

BACKGROUND

Professionals who work alone or in small teams often provide services for people with serious mental health problems in community settings. Stress is common in community teams and this may cause burnout and threaten the quality and stability of the services. This study compares levels of burnout and sources of stress among community and acute ward staff in six European centres.

METHODS

A total of 6 acute ward (N = 204) and community staff (N = 209) in 5 different European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) the Agervold Questionnaire for psychosocial work environment (QPWES) in addition to a comprehensive demographic questionnaire.

RESULTS

In the univariate analyses, except for Emotional Exhaustion (MBI), there were no differences in burnout between the two groups of staff. Community teams reported more organisational problems, higher work demands, less contact with colleagues, but also better social relations and more control over their work. The ward staff was more satisfied with the organisational structure and access to colleagues, but complained about lack of control over operating conditions at work. The multivariate analyses identified four groups of staff: (1) a Control-dissatisfied and Contact satisfied group (N = 184) with 2/3 coming from the wards. (2) A Contact-satisfied and Work-demand dissatisfied group (N = 147) with (3/4) from the community staff. (3) A Control- and Contact dissatisfied group (N = 47) with a majority from community teams, and (4) a Contact- and Work demand satisfied group (N = 37) with a majority from the wards.

CONCLUSION

Burnout as measured was not a serious problem among community and ward staff members, and did not differentiate between the two groups. Acute ward working implied lack of control but much contact with colleagues, whereas community work entailed more control but demanding work in terms of difficult task and hard-to-find-solutions.

Closeness, chaos and crisis: the attractions of working in acute mental health care

This paper makes a case for the attractiveness of acute mental health inpatient nursing (acute nursing) and argues that an altered perception of this work is essential if we are to provide the most acutely mentally ill and vulnerable people with a stable and expert nursing workforce. The discussion draws on an ethnographic study conducted in an inner-city psychiatric unit in England and the advantages of this method for understanding nursing work are described. Within our findings, we set out two overarching themes: the contextual realities of the contemporary acute ward and features of attraction that encourage nurses to work in the acute care setting. The former includes nurses' responsibility for the total ward environment and the latter the 'comfort of closeness' and 'surviving and thriving in chaos and crisis'. In conclusion, we argue that despite the unpopularity of the acute inpatient mental health environment, the highly sophisticated skills employed by acute nurses actually ensure the promotion of health for the majority of service users.

Sources of stress experienced by occupational therapists and social workers in mental health settings

This study examined the sources of stress experienced by occupational therapists and social workers employed in Australian public mental health services and identified the demographic and work-related factors related to stress using a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. The overall response rate to the survey was 76.6%, consisting of 196 occupational therapists and 108 social workers. Results indicated that lack of resources, relationships and conflicts with other professionals, workload, and professional self-doubt were correlated with increased stress. Working in case management was associated with stress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists and social workers experience stress, with social workers reporting slightly more overall stress than occupational therapists.