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Bella VD, Fiorini J, Gioiello G, Zaghini F, Sili A. Towards a New Conceptual Model for Nurses' Organizational Well-being: An Integrative Review. J Nurs Manag 2022; 30:2833-2844. [PMID: 35943839 DOI: 10.1111/jonm.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
AIM To summarize conceptual models of nurses' organizational well-being and identify common variables among them. BACKGROUND To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than healthcare, and not always considering the particularities of the profession of nursing. Evaluation This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. Key issues Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model, the Job Demands-Resources (JD-R) model, the Utriainen et al. model, the Demands-Resources and Individual-Effects (DRIVE) model, the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model, and the Nursing Worklife Model (NWM). CONCLUSION There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being, or on working environment characteristics to be studied or monitored for defining nurses' well-being. IMPLICATIONS FOR NURSING MANAGEMENT Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality, and in improving nursing performance and caring outcomes.
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Affiliation(s)
- Valerio Della Bella
- MSN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Jacopo Fiorini
- Research Nurse, Nursing Department, Tor Vergata University Hospital, Rome, Italy
| | - Giovanni Gioiello
- MSN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Zaghini
- Research Nurse, Nursing Department, Tor Vergata University Hospital, Rome, Italy
| | - Alessandro Sili
- Director of Nursing Department, Tor Vergata University Hospital, Rome, Italy
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Acceptance and commitment therapy on perceived stress and psychological flexibility of psychiatric nurses: a randomized control trial. BMC Nurs 2021; 20:239. [PMID: 34844575 PMCID: PMC8630882 DOI: 10.1186/s12912-021-00763-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Nursing in psychiatric wards is considered a highly stressful career due to the type of patients and the problem of communicating with them. Finding appropriate solutions to overcome this stress can improve the general health of nurses and improve their quality of work. The aim was to investigate the impact of Acceptance and Commitment Therapy (ACT) on the perceived stress (PS) and psychological flexibility (PF) of nurses in psychiatric wards. Methods A total of 70 nurses of Razi Psychiatric Center of Tehran were randomly selected and divided into two experimental and control groups of 35. In addition to routine interventions, the experimental group was provided with eight 2-h sessions of ACT training, whereas the control group only received routine interventions. Prior to the intervention sessions and a month after the last session, demographic information, PS scale, and Acceptance and Action Questionnaire (2nd Edition) were completed in both groups. Results There was a significant difference regarding the PS level (P = 0.002) and PF (P = 0.001) in the control and experimental groups; the experimental group showed lower PS and higher PF. Conclusions ACT can lead to reduced PS and improved PF, which can be considered as a solution to empower nurses working in psychiatric wards. Trial registration This was registered in Iranian Registry of Clinical Trials (IRCT) (clinical trial code: IRCT20180506039557N1. Registered 2018-10-31. Retrospectively registered, https://en.irct.ir/trial/31040
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Välimäki M, Hipp K, Chen J, Huang X, Guo J, Wong MS. Sensor technology to monitor health, well-being and movement among healthcare personnel at workplace: a systematic scoping review protocol. BMJ Open 2021; 11:e054408. [PMID: 34764179 PMCID: PMC8587619 DOI: 10.1136/bmjopen-2021-054408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The well-being and health of healthcare personnel is becoming increasingly important in the delivery of high-quality healthcare. The recent developments in technology have provided new opportunities for the objective detection of a wide variety of real-world properties and movement. However, technologies that are used to monitor health, well-being and movement among healthcare personnel have not been fully synthesised. The overall aim of this scoping review is to examine what type of sensor technology is available to monitor the health, well-being and movement of healthcare personnel in healthcare settings. More specifically, we want to explore what types of sensor technology applications, for what purposes and how they have been used to monitor health, well-being and movement among healthcare personnel in different workplace settings. METHODS AND ANALYSIS This scoping review protocol will follow Arksey and O'Malley's methodology, complemented by the approach of the Joanna Briggs Institute to scoping reviews and guidance for conducting systematic scoping reviews. Peer-reviewed literature will be identified using a search strategy developed by a librarian, and a wide range of electronic datasets of medical, computer and information systems disciplines will be used. Eligibility of the articles will be determined using a two-stage screening process consisting of (1) a title and abstract scan, and (2) a full-text review. Extracted data will be thematically analysed and validated by an expert of sensor technology and a group of nurses as stakeholders. Descriptive statistics will be calculated when necessary. ETHICS AND DISSEMINATION The results obtained from the review will inform what technology has been used, how it has been used in healthcare settings and what types of technology might still be needed for future innovations. Findings of the scoping review will be published in a peer-reviewed journal. REGISTRATION This review was submitted in Open Science Framework on 12 December 2020.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Kirsi Hipp
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jiarui Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Campbell AA, Harlan T, Campbell M, Mulekar MS, Wang B. Nurse's Achilles Heel: Using Big Data to Determine Workload Factors That Impact Near Misses. J Nurs Scholarsh 2021; 53:333-342. [PMID: 33786985 DOI: 10.1111/jnu.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore how big data can be used to identify the contribution or influence of six specific workload variables: patient count, medication count, task count call lights, patient sepsis score, and hours worked on the occurrence of a near miss (NM) by individual nurses. DESIGN A correlational and cross-section research design was used to collect over 82,000 useable data points of historical workload data from the three unique systems on a medical-surgical unit in a midsized hospital in the southeast United States over a 60-day period. Data were collected prior to the start of the Covid-19 pandemic in the United States. METHODS Combined data were analyzed using JMP Pro version 12. Mean responses from two groups were compared using a t-test and those from more than two groups using analysis of variance. Logistic regression was used to determine the significance of impact each workload variable had on individual nurses' ability to administer medications successfully as measured by occurrence of NMs. FINDINGS The mean outcome of each of the six workload factors measured differed significantly (p < .0001) among nurses. The mean outcome for all workload factors except the hours worked was found to be significantly higher (p < .0001) for those who committed an NM compared to those who did not. At least one workload variable was observed to be significantly associated (p < .05) with the occurrence or nonoccurrence of NMs in 82.6% of the nurses in the study. CONCLUSIONS For the majority of the nurses in our study, the occurrence of an NM was significantly impacted by at least one workload variable. Because the specific variables that impact performance are different for each individual nurse, decreasing only one variable, such as patient load, will not adequately address the risk for NMs. Other variables not studied here, such as education and experience, might be associated with the occurrence of NMs. CLINICAL RELEVANCE In the majority of nurses, different workload variables increase their risk for an NM, suggesting that interventions addressing medication errors should be implemented based on the individual's risk profile.
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Affiliation(s)
- Amy A Campbell
- Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Todd Harlan
- Chair and Professor, College of Nursing, Department of Community Mental Health, University of South Alabama, Mobile, AL, USA
| | - Matt Campbell
- Professor, School of Computing, Department of Information Systems Technology, University of South Alabama, Mobile, AL, USA
| | - Madhuri S Mulekar
- Chair and Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
| | - Bin Wang
- Professor, Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, USA
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Lee HY, Jang MH, Jeong YM, Sok SR, Kim AS. Mediating Effects of Anger Expression in the Relationship of Work Stress with Burnout among Hospital Nurses Depending on Career Experience. J Nurs Scholarsh 2021; 53:227-236. [PMID: 33522679 PMCID: PMC8014183 DOI: 10.1111/jnu.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 10/29/2022]
Abstract
OBJECTIVES This study examined the mediating effects of anger expression in the relationship between work stress and burnout among nurses with more than or less than 3 years of career experience. METHODS A cross-sectional study was conducted with 454 nurses working at three university hospitals in South Korea. Nurses completed a survey consisting of demographic questions, the Maslach Burnout Inventory, the Work Stress Scale, and the Korean version of the Anger Expression Inventory. A multiple-group mediation analysis was performed using structural equation modeling. RESULTS In total (N = 454), work stress directly affected burnout, and all anger expressions indirectly affected the relationship of work stress with burnout. Different mediating effects of anger expression style according to career experience were shown; anger-out and anger-in in nurses with less experience (n = 184) and only anger-in in those with more experience (n = 270) partially mediated the relationship of work stress with burnout. CONCLUSIONS AND CLINICAL RELEVANCE The indirect effect of anger-in style was higher than other anger expression styles in all nurses; suppression of anger caused by work stress can increase burnout. Anger-out played a functional role in the relationship of work stress with burnout among nurses who had less career experience. Therefore, to reduce burnout, creating a work environment with collaborative culture including authentic leadership and providing anger management programs will help to manage nurses' anger properly. For new nurses, promoting work and life balance, and creating a culturally empowering work environment to help them use anger-out expression constructively, are important to reduce burnout.
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Affiliation(s)
- Hye Yeong Lee
- Graduate, Department of Health Service, Graduate School of Public Policy and Civic Engagement, Kyung Hee University, Seoul, Republic of Korea
| | - Mi Heui Jang
- Professor, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Yoo Mi Jeong
- Assistant Professor, College of Nursing, Dankook University, Cheonan-si, Republic of Korea
| | - Sohyune R Sok
- Professor, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Ae Sil Kim
- Graduate, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
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Abekah-Nkrumah G, Nkrumah J. Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana. PLoS One 2021; 16:e0244726. [PMID: 33493181 PMCID: PMC7833094 DOI: 10.1371/journal.pone.0244726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Quality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior. Methods Using a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees. Results Perceived internal communication of patient-centered care strategies (β = 0.23; P<0.001), supervisor support (β = 0.31; P<0.001), coworker support (β = 0.50; P<0.001), and working conditions (β = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees’ patient-centered behavior were perceived coworker support (β = 0.51; P<0.001) and job characteristics (β = 0.16; P<0.01). Conclusion The work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.
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Affiliation(s)
- Gordon Abekah-Nkrumah
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Greater Accra Region, Ghana
- * E-mail: , (GA); acqui, (JN)
| | - Jacqueline Nkrumah
- Faculty of Science Education, Department of Health Administration and Education, University of Education, Winneba, Central Region, Ghana
- * E-mail: , (GA); acqui, (JN)
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Lorente L, Vera M, Peiró T. Nurses´ stressors and psychological distress during the COVID-19 pandemic: The mediating role of coping and resilience. J Adv Nurs 2021; 77:1335-1344. [PMID: 33210768 PMCID: PMC7753515 DOI: 10.1111/jan.14695] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/26/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
Aims This study analyses the cross‐sectional effect of sources of stress during the peak of COVID‐19 pandemic on nurses´ psychological distress, focusing on the mediating role of coping strategies, both problem focused and emotion focused and resilience. Design Cross‐sectional and quantitative analyses. Methods Structural equation modelling was performed using survey data obtained during the period between 1 April‐25 May 2020 in a sample of 421 nurses from 39 Spanish provinces. Results Results confirmed that: (a) All the stressors have a significant, direct, and negative relationship with nurses´ psychological distress; (b) Emotion‐focused strategies is negatively related to nurses´ psychological distress directly and indirectly through resilience; and (c) Problem‐focused strategies is positively related to nurses´ psychological distress and negatively and indirectly through emotion‐focused strategies. Conclusion This study identifies an important mediation sequence of stressors on psychological distress through the simultaneous concurrent effect of Problem‐focused and Emotion‐focused strategies and resilience. It shows that enacting the two coping mechanisms and resilience resources is important to achieve an adaptive effect on nurses´ mental health. Impact Nurses with insufficient preparation and those with high levels of fear of contagion do not enact proper coping strategies. Thus, these nurses need special consideration due to their risk of higher vulnerability.
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Affiliation(s)
| | - María Vera
- Pablo Olavide University, Sevilla, Spain
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8
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Teleş M. Validity and reliability of the Turkish version of the General Work Stress Scale. J Nurs Manag 2020; 29:710-720. [PMID: 33174261 DOI: 10.1111/jonm.13211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022]
Abstract
AIM To test the validity and reliability of the Turkish version of the General Work Stress Scale. BACKGROUND Nursing is one of the most stressful professions. The primary measure that should be taken to ensure that nurses can cope with stress is determining their stress levels. METHOD The General Work Stress Scale was translated into Turkish via back-translation. Its reliability and validity were analysed via item analyses, content and construct validities, exploratory and confirmatory factor analyses, Cronbach's alpha and Spearman-Brown reliability coefficients. Average and standard deviations of the scale items and the overall scale were calculated. RESULTS The study was conducted with 276 nurses. The Cronbach's alpha of the whole scale was 0.91, and the Spearman-Brown reliability coefficient was 0.89. According to the resulting one-dimensional structure, the factor loadings of the scale items were between 0.67 and 0.82, and this structure alone explained 58.72% of the total variance. The confirmatory factor analysis revealed perfect and good-fit indices (χ2 /df = 1.96; RMSA = 0.06; CFI = 0.99; IFI = 0.99; GFI = 0.97; RMR = 0.04; NFI = 0.99). The mean total score was 2.55 ± 0.87, while the items' means ranged from 2.10 ± 1.15 to 3.33 ± 1.13. CONCLUSION The Turkish version of the General Work Stress Scale is a valid and reliable tool for assessing nurses' general work stress. Nurses largely feel that their work makes them so stressed that they wish they had a different job. The items with high means suggest opportunities for improvement. IMPLICATIONS FOR PRACTICE The nurses or nursing services and units with low or high stress levels can be determined with the General Work Stress Scale. If necessary, measures aimed at eliminating or reducing the negative effects of those nurses or nursing services and units with high stress levels can be taken in a timely manner.
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Affiliation(s)
- Mesut Teleş
- Department of Health Management, Niğde Zübeyde Hanım School of Health, Niğde Ömer Halisdemir University, Niğde, Turkey
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Johnston DW, Allan JL, Powell DJH, Jones MC, Farquharson B, Bell C, Johnston M. Why does work cause fatigue? A real-time investigation of fatigue, and determinants of fatigue in nurses working 12-hour shifts. Ann Behav Med 2020; 53:551-562. [PMID: 30124742 DOI: 10.1093/abm/kay065] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation, attention, and goal-directed effort (e.g. motivational control theory). PURPOSE To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working. METHODS One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predict fatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min. RESULTS Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceived control over work and perceived reward associated with work. CONCLUSIONS Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue is consistent with a motivational account of fatigue.
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Czuba KJ, Kayes NM, McPherson KM. Support workers' experiences of work stress in long-term care settings: a qualitative study. Int J Qual Stud Health Well-being 2020; 14:1622356. [PMID: 31156047 PMCID: PMC6566720 DOI: 10.1080/17482631.2019.1622356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Support-workers’ performance and well-being are challenged by increasingly high workloads and poor working conditions, leading to high levels of occupational stress. Aims: To explore the experiences of work stress for support-workers in New Zealand residential facilities. Design: An Interpretive Descriptive study. Methods: Data from ten (n = 10) support-workers were collected between December 2013 and June 2014, using semi-structured in-depth face-to-face interviews. Thematic analysis was used to identify key themes that captured participant reports of their experiences. Results: Work stress was conceptualized by participants as being an everyday experience of having too much to deal with and feeling under constant pressure. It appeared to be a complex and fluid experience representing an inherent, dynamic tension between reasons to be a caregiver and the burden of caregiving. Participants highlighted a range of influencing factors (including lack of recognition, person and work context, and coping strategies), which may account for that fluidity. Conclusion: The findings extend current knowledge about support-workers’ work stress by identifying the challenges relating to the lack of recognition of their role and expertize, the unintended consequences of person-centered care and the challenges faced by migrant support-workers.
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Affiliation(s)
- Karol J Czuba
- a Centre for Person Centred Research , Auckland University of Technology , Auckland , New Zealand
| | - Nicola M Kayes
- a Centre for Person Centred Research , Auckland University of Technology , Auckland , New Zealand
| | - Kathryn M McPherson
- a Centre for Person Centred Research , Auckland University of Technology , Auckland , New Zealand.,b Health Research Council , Auckland University of Technology , Auckland , New Zealand
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Wollesen B, Hagemann D, Pabst K, Schlüter R, Bischoff LL, Otto AK, Hold C, Fenger A. Identifying Individual Stressors in Geriatric Nursing Staff-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193587. [PMID: 31557867 PMCID: PMC6802224 DOI: 10.3390/ijerph16193587] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 12/19/2022]
Abstract
Background: Nurses in geriatric care are exposed to various burdens in the workplace that result in high stress levels. The perceived stress may result in a lack of professional caring and burnout. Objectives: The study aim was to identify work-related and personal factors that determine stress levels to design tailored interventions. Research design: cross-sectional study. Subjects:N = 195 geriatric nursing staff members. Measures: The survey included validated questionnaires (Trier Inventory for Chronic Stress (TICS), Health Survey Short form 12 (SF-12), Nordic Questionnaire) to identify work-related burdens, resulting stress levels and work-related behavior (AVEM). According to the limits of the Screening Subscale for chronic stress (SSCS) of the TICS, nurses were classified as stressed or non-stressed. With four-step regression analysis, main predictors for the stress level were identified. Results: The analysis revealed body postures, handling heavy loads, time pressure, deadlines and pressure to perform as the main burdens of the participants. Chronically stressed nurses showed different work patterns in comparison to nurses with lower stress levels. The regression analysis showed significance for the models including the work-related patterns and resilience aspects (step three (F (3.42) = 4.168; p = 0.010) and four (F (7.35) = 4.194; p = 0.002). Pattern B was a main factor for determining stress. The stress level determined the perceived burdens. Conclusions: Experiencing and managing stressors depends on the individual’s perception, while coping patterns—especially pattern B—can be decisive. The tailored interventions to reduce stress in geriatric nurses should focus on personal patterns.
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Affiliation(s)
- Bettina Wollesen
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Diane Hagemann
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Katharina Pabst
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Ramona Schlüter
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Laura L Bischoff
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Ann-Kathrin Otto
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Carolin Hold
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
| | - Annika Fenger
- Human Movement Science, University of Hamburg, Mollerstraße 10, 20148 Hamburg, Germany.
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12
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Bischoff LL, Otto AK, Hold C, Wollesen B. The effect of physical activity interventions on occupational stress for health personnel: A systematic review. Int J Nurs Stud 2019; 97:94-104. [DOI: 10.1016/j.ijnurstu.2019.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/11/2022]
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Exploring nurses' work-related stress in an acute care hospital in KSA. J Taibah Univ Med Sci 2019; 14:376-382. [PMID: 31488971 PMCID: PMC6717074 DOI: 10.1016/j.jtumed.2019.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 02/03/2023] Open
Abstract
Objectives This study aimed to assess the perceived work-related-stress of staff nurses and determine the relationship between work-related stress and demographic profile. Methods This study used a descriptive cross-sectional design and was conducted in a secondary public hospital (staff nurses = 178, bed capacity = 225) in Riyadh, KSA. The hospital provides medical and surgical services that are important to achieve optimum quality patient care and services. In total, 178 staff nurses were interviewed, but 15 responses were excluded because of missing data (response rate: 92.52%). Results Nurses reported a moderately stressful work environment. Nationality was found to be a significant predictor of nurses' stress levels. Indian nurses had higher stress levels compared with nurses of other nationalities. Working hours per week was another significant predictor of stress. Conclusion This study highlighted perceived work-related stress of staff nurses and determined the relationship between work-related stress and demographic profile. Most nurses were moderately stressed. Working hours were associated directly with stress level. The study findings can serve as a guide for establishing human resources policies aiming at reducing nurses' stress and, thereby, promoting improved health care and task force work performance.
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Cain CD. The Effects of Prayer as a Coping Strategy for Nurses. J Perianesth Nurs 2019; 34:1187-1195. [PMID: 31301963 DOI: 10.1016/j.jopan.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/03/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the effects of prayer as a coping strategy for nurses. DESIGN Quantitative descriptive design. METHODS The population was the 15,000 members of the American Society of Perianesthesia Nurses. Twelve hundred fifty nine subjects completed a demographic questionnaire and the Prayer Functions Scale. The surveys were available on SurveyMonkey.com for 2 weeks in the fall of 2014. FINDINGS Results indicated at α = 0.05 that the nurses surveyed experienced the effects of prayer, providing assistance, providing acceptance, providing calm, and deferring as benefits of use of prayer as a coping strategy. CONCLUSIONS Reduction of nurses' stress through prayer is one way to ameliorate the ill effects that can impact nurses through stress. Nursing administration, nursing organizations, and academics could consider use of prayer as an effective coping mechanism in teaching, studying, and exploration of methods to help nurses cope with the inherent stressors of their profession.
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Affiliation(s)
- Cynthia D Cain
- Cynthia D. Cain, MS, RN, Oklahoma Wesleyan University, Bartlesville, OK.
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Keykaleh MS, Safarpour H, Yousefian S, Faghisolouk F, Mohammadi E, Ghomian Z. The Relationship between Nurse's Job Stress and Patient Safety. Open Access Maced J Med Sci 2018; 6:2228-2232. [PMID: 30559893 PMCID: PMC6290432 DOI: 10.3889/oamjms.2018.351] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety is a key element of the quality of health services. Nurses are the largest group that care for patients, observing safe in nursing care would reduce injuries, disability, morbidity and mortality. However, high stress can lead to a decline in the quality of nursing care. AIM This study aimed to investigate the relationship between job stress of the nurses and patient safety in a teaching hospital of Hamadan in 2017. MATERIAL AND METHODS This is a cross-sectional study. The data was gathered by a questionnaire of Nurse's job stress prepared by the researcher that after confirming the validity and reliability was completed by 198 nurses of three teaching hospitals of Hamadan city that were selected by simple random sampling and the checklist of patient safety that was collected by the researcher. Data analysis was done in the two levels of descriptive and analysis statistics. RESULTS The results showed that the job stress of the nurses and patient safety (mean = 1.75 and SD = 0.114) have been at an average level. There was no statistically significant relationship between Nurse's job stress and patient safety because the Spearman correlation coefficient showed that r = 0.007 and p = 0.919. Among the demographic factors, there was only a significant relationship between marital status and Nurse's job stress (p < 0.05). CONCLUSION Because of nursing job stress is affected by different working conditions, further studies in the many hospitals are needed. Moderate levels of patient safety are not acceptable; Therefore, heath's policymakers should focus on providing the safety of all patients at the optimal level, with more effort to reduce the stress of their nurses at the lowest level.
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Affiliation(s)
- Meysam Safi Keykaleh
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Safarpour
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Yousefian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Faghisolouk
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Zohreh Ghomian
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim J, Marcusson-Clavertz D, Togo F, Park H. A Practical Guide to Analyzing Time-Varying Associations between Physical Activity and Affect Using Multilevel Modeling. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:8652034. [PMID: 30105083 PMCID: PMC6076963 DOI: 10.1155/2018/8652034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
There is growing interest in within-person associations of objectively measured physical and physiological variables with psychological states in daily life. Here we provide a practical guide with SAS code of multilevel modeling for analyzing physical activity data obtained by accelerometer and self-report data from intensive and repeated measures using ecological momentary assessments (EMA). We review previous applications of EMA in research and clinical settings and the analytical tools that are useful for EMA research. We exemplify the analyses of EMA data with cases on physical activity data and affect and discuss the future challenges in the field.
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Affiliation(s)
- Jinhyuk Kim
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - David Marcusson-Clavertz
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, Lund University, Lund, Sweden
| | - Fumiharu Togo
- Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Hyuntae Park
- Department of Health Care and Science, College of Health Science, Dong-A University, Busan, Republic of Korea
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The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan. Appl Nurs Res 2018; 40:39-44. [DOI: 10.1016/j.apnr.2017.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/20/2022]
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Puerto JC, Soler LM, Montesinos MJL, Marcos AP, Chorda VMG. A new contribution to the classification of stressors affecting nursing professionals. Rev Lat Am Enfermagem 2017; 25:e2895. [PMID: 28562702 PMCID: PMC5465996 DOI: 10.1590/1518-8345.1240.2895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/14/2017] [Indexed: 12/02/2022] Open
Abstract
Objective: to identify and classify the most important occupational stressors affecting
nursing professionals in the medical units within a hospital. Method: quantitative-qualitative, descriptive and prospective study performed with Delphi
technique in the medical units of a general university hospital, with a sample of
30 nursing professionals. Results: the stressors were work overload, frequent interruptions in the accomplishment of
their tasks, night working, simultaneity of performing different tasks, not having
enough time to give emotional support to the patient or lack of time for some
patients who need it, among others. Conclusion: the most consensual stressors were ranked as work overload, frequent interruptions
in the accomplishment of their tasks, night working and, finally, simultaneity of
performing different tasks. These results can be used as a tool in the clinical
management of hospital units, aiming to improve the quality of life of nursing
professionals, organizational models and, in addition, continuous improvement in
clinical treatment.
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Richner SC, Cullati S, Cheval B, Schmidt RE, Chopard P, Meier CA, Courvoisier DS. Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare. Health Qual Life Outcomes 2017; 15:56. [PMID: 28340584 PMCID: PMC5364621 DOI: 10.1186/s12955-017-0630-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/13/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The regret intensity scale (RIS) and the regret coping scale for healthcare professionals (RCS-HCP) working in hospitals assess the experience of care-related regrets and how healthcare professional deal with these negative events. The aim of this study was to validate a German version of the RIS and the RCS-HCP. METHODS The RIS and RCS-HCP in German were first translated into German (forward- and backward translations) and then pretested with 16 German-speaking healthcare professionals. Finally, two surveys (test and 1-month retest) administered the scales to a large sample of healthcare professionals from two different hospitals. RESULTS Of the 2142 eligible healthcare professionals, 494 (23.1%) individuals (108 physicians) completed the cross-sectional web based survey and 244 completed the retest questionnaire. Participants (n = 165, 33.4% of the total sample) who reported not having experienced a regret in the last 5 years, had significantly more days of sick leave during the last 6 months. These participants were excluded from the subsequent analyses. The structure of the scales was similar to the French version with a single dimension for the regret intensity scale (Cronbach's alpha: 0.88) and three types of coping strategies for the regret coping scale (alphas: 0.69 for problem-focused strategies, 0.67 for adaptive strategies and 0.86 for the maladaptive strategies). Construct validity was good and reproduced the findings of the French study, namely that higher regret intensity was associated with situations that entailed more consequences for the patients. Furthermore, higher regret intensity and more frequent use of maladaptive strategies were associated with more sleep difficulties and less work satisfaction. CONCLUSIONS The German RIS and RCS-HCP scales were found valid for measuring regret intensity and regret coping in a population of healthcare professionals working in a hospital. Reporting no regret, which corresponds to the coping strategy of suppression, seems to be a maladaptive strategy because it was associated with more frequent sick day leaves.
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Affiliation(s)
- Silvia C Richner
- Department of Internal Medicine and Specialties, Stadtspital Triemli, Zurich, Switzerland
| | | | - Boris Cheval
- Geneva University Hospitals, Geneva, Switzerland.
| | | | | | - Christoph A Meier
- Office of the Chief Medical Officer, University Hospital Basel, Basel, Switzerland
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Johnston D, Bell C, Jones M, Farquharson B, Allan J, Schofield P, Ricketts I, Johnston M. Stressors, Appraisal of Stressors, Experienced Stress and Cardiac Response: A Real-Time, Real-Life Investigation of Work Stress in Nurses. Ann Behav Med 2016; 50:187-97. [PMID: 26608281 PMCID: PMC4823345 DOI: 10.1007/s12160-015-9746-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Stress in health care professionals may reflect both the work and appraisal of work and impacts on the individuals, their patients, colleagues and managers. PURPOSE The purpose of the present study is to examine physiological and psychological effects of stressors (tasks) and theory-based perceptions of work stressors within and between nurses in real time. METHODS During two work shifts, 100 nurses rated experienced stress, affect, fatigue, theory-based measures of work stress and nursing tasks on electronic diaries every 90 min, whereas heart rate and activity were measured continuously. RESULTS Heart rate was associated with both demand and effort. Experienced stress was related to demand, control, effort and reward. Effort and reward interacted as predicted (but only within people). Results were unchanged when allowance was made for work tasks. CONCLUSIONS Real-time appraisals were more important than actual tasks in predicting both psychological and physiological correlates of stress. At times when effort was high, perceived reward reduced stress.
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Affiliation(s)
- Derek Johnston
- School of Psychology, College of Life Sciences and Medicine, University of Aberdeen, Kings College, Old Aberdeen, Aberdeen, AB24 3FX, UK.
| | | | | | | | | | - Patricia Schofield
- Greenwich University, London, UK.,Anglia Ruskin University, Chelmsford, UK
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Durkin M, Beaumont E, Hollins Martin CJ, Carson J. A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses. NURSE EDUCATION TODAY 2016; 46:109-114. [PMID: 27621200 DOI: 10.1016/j.nedt.2016.08.030] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses. AIM To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses. METHOD Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout. PARTICIPANTS A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study. RESULTS Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout. CONCLUSION High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.
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Affiliation(s)
- Mark Durkin
- School of Health and Human Sciences, University of Bolton, BL3 5AB, UK.
| | - Elaine Beaumont
- School of Nursing, Midwifery, Social Work & Social Sciences Mary Seacole Building, (Room MS3.17), University of Salford, Frederick Road, Salford, Greater Manchester M6 6PU, UK.
| | | | - Jerome Carson
- School of Education and Psychology, University of Bolton, BL3 5AB, UK.
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Karpavičiūtė S, Macijauskienė J. The Impact of Arts Activity on Nursing Staff Well-Being: An Intervention in the Workplace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:435. [PMID: 27104550 PMCID: PMC4847097 DOI: 10.3390/ijerph13040435] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 03/20/2016] [Indexed: 11/16/2022]
Abstract
Over 59 million workers are employed in the healthcare sector globally, with a daily risk of being exposed to a complex variety of health and safety hazards. The purpose of this study was to investigate the impact of arts activity on the well-being of nursing staff. During October-December 2014, 115 nursing staff working in a hospital, took part in this study, which lasted for 10 weeks. The intervention group (n = 56) took part in silk painting activities once a week. Data was collected using socio-demographic questions, the Warwick-Edinburgh Mental Well-Being Scale, Short Form-36 Health Survey questionnaire, Reeder stress scale, and Multidimensional fatigue inventory (before and after art activities in both groups). Statistical data analysis included descriptive statistics (frequency, percentage, mean, standard deviation), non-parametric statistics analysis (Man Whitney U Test; Wilcoxon signed-ranks test), Fisher's exact test and reliability analysis (Cronbach's Alpha). The level of significance was set at p ≤ 0.05. In the intervention group, there was a tendency for participation in arts activity having a positive impact on their general health and mental well-being, reducing stress and fatigue, awaking creativity and increasing a sense of community at work. The control group did not show any improvements. Of the intervention group 93% reported enjoyment, with 75% aspiring to continue arts activity in the future. This research suggests that arts activity, as a workplace intervention, can be used to promote nursing staff well-being at work.
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Affiliation(s)
- Simona Karpavičiūtė
- Department of Social Sciences and Humanities, Lithuanian University of Health Sciences, Šiaurės pr. 57, LT-49264 Kaunas, Lithuania.
| | - Jūratė Macijauskienė
- Faculty of Nursing, Lithuanian University of Health Sciences, Eivenių g. 4, LT-50161 Kaunas, Lithuania.
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de la Fuente EI, García J, Cañadas GA, San Luis C, Cañadas GR, Aguayo R, de la Fuente L, Vargas C. Psychometric properties and scales of the Granada Burnout Questionnaire applied to nurses. Int J Clin Health Psychol 2015; 15:130-138. [PMID: 30487830 PMCID: PMC6224776 DOI: 10.1016/j.ijchp.2015.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/26/2022] Open
Abstract
Nurses are an occupational group with extremely high levels of burnout. The most accepted definition of the burnout syndrome was proposed by Maslach and Jackson, who characterized it in terms of three dimensions: (i) Emotional Exhaustion; (ii) Depersonalization; (iii) Personal Accomplishment. This definition was the basis for the Granada Burnout Questionnaire (GBQ). The objective of this research was to evaluate the psychometric properties of the GBQ and to elaborate an evaluation scale to measure burnout in nursing professionals in Spain. A total of 1,177 nurses participated in this study and successfully completed the GBQ. Evidence of construct validity was verified by cross-validation and convergent validity, and evidence of criteria validity was checked by concurrent validity. Cronbach's alpha was used to measure internal consistency. The results obtained in our study show satisfactory fit values in the confirmatory factor analysis and in the evidence of convergent and concurrent validity. All of the Cronbach alpha values were greater than .83. This signifies that the GBQ has good psychometric properties that are applicable to nurses. For this purpose a scale of T-scores and centiles was created that permitted the evaluation of burnout in Spanish nursing professionals.
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Affiliation(s)
- Emilia I de la Fuente
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
| | | | | | | | | | | | | | - Cristina Vargas
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
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van der Colff JJ, Rothmann S. Occupational stress of professional nurses in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2014.980626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Sebastiaan Rothmann
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Farquharson B, Bell C, Johnston D, Jones M, Schofield P, Allan J, Ricketts I, Morrison K, Johnston M. Frequency of nursing tasks in medical and surgical wards. J Nurs Manag 2013; 21:860-6. [DOI: 10.1111/jonm.12110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 11/27/2022]
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