Relationship between occupational stress and coping strategy among operating theatre nurses in China: a questionnaire survey

Incidence of effort-reward imbalance among nurses: a systematic review and meta-analysis

Introduction

To systematically evaluate the incidence of effort-reward imbalance among nurses.

Method

PubMed, Web of Science, Embase, CNKI, WanFang Data, and VIP databases were searched to collect studies on the incidence of effort-reward imbalance among nurses. The search timeframe was from database construction to December 2023. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. The meta-analysis was performed using Stata 17.1 software.

Results

A total of 60 studies, including 79,644 participants, were included. The prevalence of effort-reward imbalance among nurses was 52.3% (95% CI: 44.9-59.7%). In terms of time, the incidence of effort-reward imbalance among nurses before 2010 (26.6, 95%CI: 6.8-46.4%) and in 2010-2015 (42.4, 95%CI: 32.1-52.8%), 2016-2020 (60.2, 95%CI: 49.6-70.7%), and 2021-2023 (65.0, 95%CI: 51.5-78.4%) continued to increase. Geographically, Asia (57.4, 95%CI: 51.8-63.1%) nurses had a relatively higher prevalence of effort-reward imbalance. In terms of department, the incidence of effort-reward imbalance among nurses was relatively higher in operating rooms (71.8, 95%CI: 64.5-79.0%), ICU (64.6, 95%CI: 27.7-100.0%), emergency (68.7, 95%CI: 62.9-74.5%), and pediatrics (65.8, 95%CI: 32.2-99.3%).

Discussion

The prevalence of nurse effort-reward imbalance is high, and there are differences in its prevalence across time, geography, department. Hospital administrators should actively take measures to effectively prevent and reduce the effort-reward imbalance for nurses, especially for nurses in Asia, operating rooms, emergency pediatrics and ICU departments.

Systematic review registration

PROSPERO (CRD42023452428).

Job Satisfaction and Associated Factors among Scrub Nurses: Beyond the Surface

BACKGROUND

Job satisfaction is essential, especially among healthcare professionals like scrub nurses, who often face unique professional challenges. This study aimed to evaluate job satisfaction and its related factors among scrub nurses, shedding light on areas of improvement and highlighting the positive aspects of their roles.

METHODS

A detailed study was conducted among a cohort of 31 scrub nurses using a 28-question survey. The questionnaire gauged various aspects of job satisfaction, from work conditions to professional growth opportunities.

RESULTS

Notably, the participants showed the least satisfaction with hazard allowances (1.8 ± 1.1) and break durations (1.9 ± 1.3). However, high satisfaction was observed regarding resource availability (3.9 ± 1.0) and the quality of protective equipment (3.7 ± 1.0). The data also revealed that those with 6-10 years of experience were the most satisfied (3.5), while those with 16-20 years were less content (2.7).

CONCLUSION

The study indicates the need for improvements in hazard allowances and break periods. Experience significantly influenced satisfaction, with mid-career nurses showing the highest contentment. Such insights can guide future policy and practice adjustments in healthcare settings.

Mental health and job stress of nurses in surgical system: what should we care

BACKGROUND

Job stress has significant influence on the mental health of health care providers. The mental health and job stress of operating room nurses remain unclear. This study aimed to evaluate the mental health and job stress of nurses in surgical system in China, to provide evidences for clinical nurse management and care.

METHODS

The nurses in the surgical system of our hospital were investigated by questionnaire in December 2022. The general information questionnaire, symptom check list 90 (SCL-90) and nurses' job stressor scale (NJSS) were used for data collection. Pearson correlation and logistic analysis were conducted to evaluate the related influencing factors.

RESULTS

A total of 171 nurses in surgical system were investigated. The mental health level of nurses in operating room was low. The job pressure of the nurses in the operating room was in the middle level. The nursing profession and work, workload and distribution, working environment and resources, patient care, management and interpersonal relationship were all positively correlated with SCL-90 score of nurses in operating room. Logistic regression analysis indicated that age, year of work experience, professional ranks and titles both are the influencing factors of SCL-90 score and of nurses in operating room.

CONCLUSIONS

The mental health of nurses in surgical system is affected by work pressure, ages, working years and professional titles. These factors should be considered in the psychological intervention of nurses in operating room in order to improve the health of clinical nurses.

Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review

The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.

Mediating effects of social support, mental health between stress overload, fatigue and turnover intention among operating theatre nurses

BACKGROUND

The high rate of nurses turnover and nursing staff shortage have been an ongoing concern issue and a challenge for global health systems. To explore the turnover intention among operating theatre nurses, and to test the hypothetical model for estimating the effects of stress overload and fatigue between social support, mental health and turnover intention.

DESIGN

a multi-center and cross-sectional online survey.

METHODS

This study was conducted from October 2020 to March 2021 comprised 1060 operating theatre nurses from 76 Chinese hospitals. The descriptive analysis, independent sample t test and one-way analysis of variance and Spearman correlation analysis were used to explore the relationships among variables by the SPSS software, and stepwise multiple linear regression analysis was utilized to identify influencing factors of turnover intention and its dimensions among operating theatre nurses. A structural equation model was analyzed by the AMOS software.

RESULTS

Social support, mental health, stress overload and fatigue were important predictors of turnover intention among operating theatre nurses. Besides, stress overload positively affected fatigue, mental health and turnover intention; fatigue negatively affected social support, however, fatigue positively affected mental health; social support negatively affected mental health and turnover intention; mental health positively affected turnover intention. Moreover, social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.

CONCLUSION

Social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.

An observational study to assess circulating nurses' non-technical skills

BACKGROUND

Non-technical skills are cognitive and social skills that are necessary for safe and efficient practices in operating theatre. These skills are inseparable parts of circulating nurses' duties and help them have a good performance during surgical processes. Circulating nurses' non-technical skills have not been closely measured, and much uncertainty still exists about the quality of their skills. This study aimed to assess circulating nurses' non-technical skills.

METHODS

A cross-sectional study was conducted on 300 circulating nurses who worked in four public hospitals in Iran, during 2020. The data of demographics of the studied population were collected using a demographic questionnaire. Kalantari et al's Circulating Practitioner's List of Non-Technical Skills was used to assess the circulating nurses' non-technical skills.

RESULTS

The situational awareness domain had the highest score, while leadership was the domain with the lowest mean score. There was a moderate positive relationship between the mean score of non-technical skills and the number of working years as a circulating nurse.

CONCLUSION

Although the circulating nurses had a moderate level of non-technical skills, they had low scores in several behaviours. However, they did well in some other behaviours. Educational interventions and policymaking solutions can help improve circulating nurses' non-technical skills.

Influence of resilience on depression among nurses in clean operating departments: The mediating effect of life satisfaction

BACKGROUND

A clean operating room is an important part of surgical and critical treatment in hospitals. The workload is substantial, the pace is rapid, and the working environment is intense; therefore, nurses who work in clean operating rooms are constantly challenged, which can lead to anxiety, depression, and other mental health issues. Life satisfaction and resilience are important factors that ensure mental health. Therefore, exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork.

AIM

To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department.

METHODS

From April to November 2022, 196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study. Participants were selected using convenience sampling. Participants' gender, age, marital status, position, length of service, personal monthly income, daily working hours, employment status, and professional title were collected, and the Connor-Davidson resilience scale, satisfaction with life scale, and self-rating depression scale were used to evaluate resilience, life satisfaction, and depression. The researchers conducted professional training in advance, introduced the research methods to the participants before the investigation, and explained the study's significance and purpose. Surveys were distributed and collected on-site. Each questionnaire took 30 min to complete.

RESULTS

The average scores for life satisfaction, resilience, and depression were 3.13 (± 0.28), 4.09 (± 0.78), and 56.21 (± 8.70), respectively. The correlation between resilience and depression was negative (r = -0.829, P < 0.01). Life satisfaction was positively related to resilience (r = 0.855, P < 0.01) and negatively related to depression (r = -0.778, P < 0.01). The relationship between resilience and depression was partially mediated by life satisfaction. The value of the mediating effect was -6.853 (26.68% of the total effect).

CONCLUSION

Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.

The mediating role of coping styles in the relationship between second victim experience and professional quality of life among nurses: a cross-sectional study

BACKGROUND

Studies have shown that second-victim experiences could increase risks of the compassion fatigue while support from individuals and organisations is most often protection. However, the risk for poor compassion satisfaction and increased compassion fatigue in nurses aroused by adverse events remains an underestimated problem, meanwhile, litter known about the role of positive and negative coping styles among nurses suffering from adverse events. This study aims to investigate the effect of second-victim experiences on the professional quality of life among nurses and to determine the mediating role of coping styles in the relationship between second-victim experiences and professional quality of life.

METHODS

Multistage sampling was used to recruit registered nurses from Hunan province in China. Registered nurses who identified themselves as experiencing adverse events from nine tertiary hospitals were included in this study. Participants were recruited to complete a survey on the second victim experience and support tool, the simplified coping style questionnaire, and the professional quality of life scale. The stress coping theory was used to develop the framework in this study. The structural equation modelling approach was used for conducting the mediating effects analysis via IBM SPSS Statistics 26.0 and Mplus 8.3.

RESULTS

In total, 67% (n = 899) of nurses reported a second victim experience during their careers. In a bivariate analysis, both second-victims experiences and coping styles were significantly associated with their professional quality of life. The results showed that the effects of second victim experiences on their professional quality of life were fully mediated by coping styles. A total of 10 significantly indirect pathways were estimated, ranging from -0.243 to 0.173.

CONCLUSIONS

Second-victim experiences are common among nurses in this study. Since the mediating effects of coping styles were clarified in this study, it is imperative to promote the perception of negative coping styles and encourage nurses to adopt more positive coping styles with adequate support systems.

Effects of coping on nurses' mental health during the COVID-19 pandemic: Mediating role of social support and psychological resilience

BACKGROUND

Fighting against the COVID-19 pandemic, front-line nurses were under unprecedented psychological pressure. Therefore, it is necessary to promptly evaluate the psychological status of nurses during the COVID-19 epidemic period.

AIM

To investigate nurses' mental health during the COVID-19 pandemic, and to test the mediating role of social support and psychological resilience between coping and mental health.

DESIGN

This was a descriptive, cross-sectional survey which used a structural equation model.

METHOD

In total, 711 registered nurses were included. All participants were invited to complete a socio-demographic questionnaire, the general health questionnaire, the trait coping style questionnaire, the perceived social support scale and the Conner-Davidson Resilience scale.

RESULTS

In total, 50.1% nurses had high risk of mental health. Positive coping positively affected social support and psychological resilience, while it negatively affected mental health. Negative coping negatively affected social support and psychological resilience, while it positively affected mental health. Social support positively affected psychological resilience, while it negatively affected mental health. In addition, social support mediated coping and psychological resilience, and coping and mental health. Moreover, psychological resilience negatively affected mental health, and it mediated coping and mental health.

Stressors, coping strategies and intention to leave the nursing profession: A cross-sectional nationwide study in China

AIMS

This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses.

BACKGROUND

Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet.

METHOD

A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported.

RESULTS

Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect.

CONCLUSIONS

Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China.

IMPLICATIONS FOR NURSING MANAGEMENT

Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.

How robots impact nurses' time pressure and turnover intention: A two-wave study

AIMS

To examine the relationships among effort ensuring robots' smooth operation (EERSO), time pressure, missed care, and nurses' turnover intention, and how robot performance moderates such relations.

BACKGROUND

Robots may reduce nurses' workload but typically still require some effort of nurses for robots' smooth operation. However, the negative impact of EERSO on nurses' workplace outcomes is unknown.

METHODS

This study used a two-wave follow-up design. Data were collected in a medical center in Taiwan, with first wave collected in 2019 and second wave collected between 2019 and 2020. A total of 331 participants were followed through the two waves.

RESULTS

EERSO is positively linked to missed care and time pressure. Time pressure is also positively linked to missed care and turnover intention. Positive robot performance weakens the positive link between EERSO and time pressure.

CONCLUSION

Using robots may help reduce nurses' workload, but it also requires nurses' efforts to maintain robots' continuous operation, that is, EERSO. It may adversely impact nursing professional workplaces.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should reduce nurses' time pressure whilst suggest hospital managers to seek robots that require minimal EERSO.

Personality Factors as Predictors in Burnout Level Changes for Surgical Area Nurses

Surgical area nurses provide comprehensive care to patients throughout the surgical process. Increases in life expectancy lead to the appearance and development of diseases, translating into an increase in the number of necessary interventions. Increases in the workload can be another risk factor for the development of burnout in professionals in this area. Knowledge of psychological and personality-related variables provides relevant information of level changes in the dimensions of burnout syndrome. Three logistic regression models, based on a cross-sectional study with 214 nurses working in the surgical area in the Andalusian Health Service, Spain, were built for each dimension. These models included different variables related to depression and personality, with some being significant at the population level and consequently true risk or protection factors. Friendliness, responsibility and extraversion are protection factors for the personal accomplishment dimension, whilst neuroticism is a risk factor for this dimension. Friendliness is also a protection factor for depersonalization, whilst depression is a risk factor. Finally, neuroticism, responsibility and depression are risk factors for the emotional exhaustion dimension of burnout. These findings provide relevant information that makes anticipation of this syndrome in this group easier.

Stress and coping experience in Nurse Residency Programs for new graduate nurses: A qualitative meta-synthesis

Objectives

To determine the stress experience and coping styles of new nurses during Nurse Residency Programs (NRPs) by identifying, appraising, and synthesizing data from the qualitative studies.

Design

A systematic review and meta-synthesis of qualitative studies.

Review methods

Eleven databases were systematically searched for relevant publications in March 2022. All qualitative and mixed-method studies in English and Chinese that explored the stress and coping experience during NRPs of new graduate nurses were included. The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results.

Results

A total of 13 studies revealed 13 sub-themes and three descriptive themes: multi-dimensional stressors, somatic and emotional responses, coping resources and coping methods.

Conclusion

New nurses faced a lot of physical and emotional stress during NRPs, which had a negative impact on their physical and mental health. NRPs are a critical period for the career growth of new nurses. Effective management strategies must be implemented to improve nurse capacity, meet their needs, improve self-efficacy, and build organizational support, as this can improve the quality of clinical nursing and keep the enthusiasm and stability of the nursing team.

Moderated Role of Social Support in the Relationship between Job Strain, Burnout, and Organizational Commitment among Operating Room Nurses: A Cross-Sectional Study

Unique environment, coupled with overload, low job control, and high risk might put operating room (OR) nurses in a state of high job strain, which might have negative influences on burnout and organizational commitment. Based on the Job Demand-Control-Support model and previous studies, we hypothesized that the relationship between job strain (determined by job demand and control) and organizational commitment could be mediated by burnout (emotional exhaustion and depersonalization), the effect of job strain on burnout and organizational commitment could be moderated by social support. To verify the hypothesis, a quantitative cross-sectional survey was conducted, 509 OR nurses from 30 tertiary hospitals in Beijing were recruited. Multiple-group path analysis was used to test the moderated role of social support. Propensity score matching was applied to match job strain in different groups. Our research found that in the low social support group, job strain was not related to organizational commitment, while in the high social support group, depersonalization was not related to organizational commitment. Furthermore, nurses in the low social support group were more likely to have depersonalization under job strain compared to the high social support group. Social support should be provided to alleviate the negative impact of job strain.

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

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

Professional Identity and Emotional Labor Affect the Relationship between Perceived Organizational Justice and Job Performance among Chinese Hospital Nurses

AIM

To investigate the influence of perceived organizational justice, professional identity, and emotional labor on nurses' job performance.

BACKGROUND

Previous studies have not explored the impact of professional identity and emotional labor on the relationship between perceived organizational justice and job performance. However, how to mobilize the enthusiasm of nurses and improve their job performance is the key for nursing managers to realize the sustainable development of hospitals.

METHODS

A cross-sectional survey design was conducted. A total of 951 nurses from public hospitals in China participated in the survey from March-June 2021. The descriptive statistical approach, Pearson's correlation analysis, and the PROCESS Macro Model 4 and 14 in regression analysis were used to analyze the available data.

RESULTS

The results showed that nurses' perceived organizational justice, professional identity, emotional labor, and job performance were significantly positive correlations between every two variables, with coefficients ranging between 0.24-0.75. Professional identity played a whole mediating role in perceived organizational justice and job performance, accounting for 98.04% of the total effect; meanwhile, this process was moderated by emotional labor.

CONCLUSIONS

Perceived organizational justice positively predicted nurses' job performance; as a mediating mechanism with moderating, professional identity and emotional labor further explained how perceived organizational justice promoted the job performance of nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlighted the moderated mediation role of professional identity and emotional labor between nurses' perceived organizational justice and job performance. Understanding this mechanism has guiding significance for nursing managers to improve nurses' job performance.

Factors Influencing Turnover Intention Among Operating Room Nurses in South Korea

BACKGROUND

Operating room nurses experience verbal abuse, high levels of job stress, and burnout that may increase turnover intention.

PURPOSE

This study was designed to investigate and identify factors influencing turnover intention among operating room nurses in South Korea.

METHODS

This study used a cross-sectional descriptive design. The sample included 193 nurses, all of whom had over 3 months of work experience at operating rooms in hospitals in Seoul, South Korea. Measures used included the Verbal Abuse Experience Scale, Job Stress Scale, Burnout Scale, and Turnover Intention Scale.

RESULTS

Burnout was found to have the greatest influence on turnover intention (β = .34, p < .001), followed by verbal abuse (β = -.23, p = .004), job stress (β = .22, p = .001), age (β = -20, p = .032), and job satisfaction (β = -.14, p = .020).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support burnout and verbal abuse, respectively, as the most significant and second most significant predictors of turnover intention among operating room nurses in South Korea. These factors should be proactively and effectively addressed to reduce turnover intention in this important group of healthcare professionals.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches

AIMS

The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches.

DESIGN

The study followed a multisite cross-sectional design.

METHODS

A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis.

RESULTS

Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization.

CONCLUSION

Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support.

IMPACT

This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Understanding stress factors for scrub nurses in the perioperative period: A cross-sectional survey

PURPOSE OF THE STUDY

To assess the stress factors affecting operating theater nurses during the perioperative period.

PATIENTS AND METHODS

The study was conducted as a cross-sectional survey by means of a specifically drawn-up questionnaire based on the data available in the literature. Stress was measured on a 0/100 visual analogue scale (VAS).

RESULTS

Six hundred and twelve (612) persons responded. Stress associated with an operation amounted to 31.8; it was higher at the time of the procedure (49.6) and immediately beforehand (39.4), particularly among the least experienced nurses. The most widely represented stress factors were associated with the surgical team (perceived incompetence, lack of confidence), relational problems with regard to the surgeon, and team members' disruptive behavior. By contrast, familiarity with the team or the procedure seemed to shield the nurses from stress. Feelings of stress had a relatively frequent impact on quality of life (33%), family and personal life (26%), with chronic (recurrent or constant) stress symptoms reported among 20% of respondents.

CONCLUSION

Among operating theater nurses, stress associated with an operation was particularly strong among the least experienced professionals, when the type of procedure or the other team members were unfamiliar, and in the event of disruptive behavior. Stress factor improvement should be a priority, the objective being to enhance professional and personal quality of life, while better ensuring patient safety.

Where to Look for a Remedy? Burnout Syndrome and its Associations with Coping and Job Satisfaction in Critical Care Nurses-A Cross-Sectional Study

BACKGROUND

Burnout is a psychological, work-related syndrome associated with long-term exposure to emotional and interpersonal stressors in the workplace. Burnout syndrome in nurses is often caused by an imbalance between work requirements and preparation and fitness for work, a lack of control, insufficient performance recognition and a prolonged exposure to stress.

AIM

The aims of this study were to explore the associations between levels of burnout syndrome, coping mechanisms and job satisfaction in critical care nurses in multivariate modelling process. A specific aim was also to explore whether coping and job satisfaction in critical care nurses are gender related.

METHODS

A cross-sectional multicentre study was conducted in a convenience sample of 620 critical care nurses from five university hospitals in Croatia in 2017. The data were collected using the Maslach Burnout Inventory and the Ways of Coping and Job Satisfaction Scale together with the nurses' demographic profiles and were analysed using a multivariable model.

RESULTS

The results showed no significant association between gender, coping mechanisms and job satisfaction. However, significant negative associations between burnout and job satisfaction (OR = 0.01, 95%CI = 0.00-0.02, p < 0.001) and positive association between burnout and passive coping (OR = 9.93, 95%CI = 4.01-24.61, p < 0.001) were found.

CONCLUSION

The association between job satisfaction and burnout in nurses urges hospital management teams to consider actions focused on job satisfaction, probably modifications of the work environment. Given that passive coping may increase the incidence of burnout, it is recommendable for active coping to be implemented in nurses' training programmes as an essential element of capacity building aimed at reducing the incidence of burnout in nurses.

The influence of operating room nurses' job stress on burnout and organizational commitment: The moderating effect of over-commitment

AIMS

To determine job stress among Chinese operating room nurses, test the mediating effect of burnout and verify the moderating effect of over-commitment between job stress and mental health.

DESIGN

A descriptive, cross-sectional study.

METHODS

A multistage sampling method was adopted. First, a random sampling method was used to select 30 tertiary hospitals in Beijing, after which 509 operating room nurses were selected by convenience sampling from March-June 2017. Self-administered questionnaires were used to evaluate job stress, burnout, and organizational commitment among participants. Multiple-group path analysis was used to test the mediating effect and the moderating effect.

RESULTS

Of all nurses, 70.3% were in a state of job stress, which had negative effects on organizational commitment mediated by emotional exhaustion and depersonalization. The result of multiple-group path analysis showed that the path coefficients are different between the low and high groups of over-commitment. When facing job stress, operating room nurses with low over-commitment were more likely to have emotional exhaustion (β = 0.750 vs. 0.602), while those with high over-commitment were more likely to have low organizational commitment (β = -0.641 vs. -0.594).

CONCLUSION

The job stress of operating room nurses in China was high. Burnout played a mediating role between job stress and organizational commitment. Over-commitment played a moderating role in the relationship among job stress, burnout, and organizational commitment.

IMPACT

This study analysed the relationship among operating room nurses' job stress, burnout, and organizational commitment. The findings provided confirmatory support on the mediated effect of burnout between job stress and organizational commitment and the moderation effect of over-commitment. Different measures are needed to reduce job stress, as for easing burnout and improving organizational commitment among different groups of nurses.

Validity and reliability of the Turkish version of the General Work Stress Scale

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.

Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study

Aims and objectives

This study aimed to portray the prevalence and associated factors of psychological distress among frontline nurses during COVID‐19 outbreak.

Background

The COVID‐19 outbreak has posed great threat to public health worldwide. Nurses fighting against the epidemic on the frontline might be under great physical and psychological distress. This psychological distress was predominantly described as sleep disturbance, symptoms of anxiety and depression, post‐traumatic stress, inability to make decisions and even somatic symptoms.

Design

Cross‐sectional study.

Methods

Frontline nurses from designated hospitals for COVID‐19 patients were invited to complete an online survey by convenience sampling, and the survey included six main sections: the General Health Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Scale, the Impact of Event Scale‐Revised, socio‐demographic, occupation and work history. Multiple logistic analysis was used to identify the potential risk factors of psychological distress. The study methods were compliant with the STROBE checklist.

Results

Of the 263 frontline nurses, 66 (25.1%) were identified as psychological distress. Multiple logistic analysis revealed that working in emergency department, concern for family, being treated differently, negative coping style and COVID‐19‐related stress symptom were positive related to psychological distress. Perceived more social support and effective precautionary measures were negatively associated with psychological distress.

Conclusions

The study demonstrated that COVID‐19 had a significant psychological impact on frontline nurses. Early detection of psychological distress and supportive intervention should be taken according to the associated factors to prevent more serious psychological impact on frontline nurses.

Relevance to clinical practice

This study highlighted that the frontline nurses were suffering from varying degrees of psychological distress, which needed early screening and supportive intervention for preventing more serious psychological impact on frontline nurses. Beside, more specific measurement should be combined with the GHQ‐12 to assess the varying degrees of psychological distress in frontline nurses.

The effects of "Workplace Health Promotion Program" in nurses: A randomized controlled trial and one-year follow-up

In this study, the authors examined the effects of the "Workplace Health Promotion Program" (WHPP) on pain, fatigue, stress, professional quality of life (Pro-QoL), and coping skills for nurses. The authors conducted a randomized control trial in 30 nurses who agreed to participate in this study. Progressive relaxation training, posture and breath exercises, and ergonomic suggestions as a WHPP were applied to the intervention group (n = 15) during the five weeks. The intervention group showed decrease in pain (p = .001), fatigue (p = .001), and stress levels (p = .003) and increase in coping skills and Pro-QoL (p < .05). In contrast, the authors observed no improvement in the control group. The authors concluded at the end of the study that WHPP remains effective in nurses.

Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions

BACKGROUND

A growing literature has revealed a relationship between shift-work, including night-shift, and the disturbance of sleep-wake cycle, leading to insomnia and/or increased daytime sleepiness in shift nurses; recent findings showed an association between shift work sleep disorders and distress, work accidents, decreased job performance and, consequently, lower quality of health service provision and lower standards of care.

OBJECTIVES

To analyze across the gender how shift nurses experience shift work sleep disorders and job stress.

METHODS

A cross-sectional study was performed following the STROBE Statement. The Italian version of the Job Content Questionnaire, the Bergen Insomnia Scale and the Epworth Sleepiness Scale were administered to the registered nurses employed in three Departments of General Practice and Elderly Care Medicine.

RESULTS

No significant association was found between high job strain and insomnia and daytime sleepiness. Significantly more women than men experienced high job strain, insomnia and daytime sleepiness; among women the level of social support was significantly and negatively associated with insomnia and daytime sleepiness.

CONCLUSIONS

The findings of this study suggest that interventions aimed to prevent shift work sleep disorder and job stress in shift-nurses should incorporate the assessment of social support across the gender. Moreover, longitudinal studies are required to evaluate the effectiveness of interventions targeted on social support to minimize the occurrence of insomnia and daytime sleepiness in shift nurses.

Predictors of nurses' turnover intention at one and five years' time

AIM

This study examined the role of job dimensions, job satisfaction, psychological stress and job burnout in predicting turnover intention at one and five years' time among professional nurses in the Philippines.

METHODS

A cross-sectional design was utilized in the study using a convenience sample of 549 registered nurses from six hospitals in the Central Philippines during the period of October 2018 to January 2019. Five self-report scales were used in this study.

RESULTS

Overall, 46.1% (n = 253) and 78.9% (n = 433) of nurses reported planning to leave the organization at one and five years' time, respectively. The type of hospital, job satisfaction and job burnout explained variances for turnover intention at one and five years' time. Separately, hospital bed capacity and job stress predicted turnover intention at five years' time. None of the job dimensions accurately predicted turnover intention in nurses.

CONCLUSION

Higher turnover intention results at one and five years' time were dependent on nurses' psychological stress, job burnout and job satisfaction.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Organizational measures aimed at reducing stress and burnout and increasing job satisfaction in nurses are critically important to enhance the retention of nurses and ensure continued quality of nursing care.

Newly trained operating room nurses' experiences of nursing care in the operating room

There is limited research on nurses' experiences of nursing care in the operating room. The operating room nurses' responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses' experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years' work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses' searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses' experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients' well-being and working in teams for the patients' best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.

Occupational stress and its related demographic factors among Iranian CCU nurses: a cross-sectional study

Objectives

Occupational stress can have an adverse effect on mental and physical health and performance of nurses. The aim of this study was to investigate the occupational stress of Iranian critical care unit (CCU) nurses and its related demographic factors.

Results

In this cross-sectional study, 155 CCU nurses were randomly selected. The Osipow Occupational Stress Questionnaire was used as data collection tool. The mean of nurses’ occupational stress was 210.13 ± 40.87 out of 300, which was at the “moderate-to-high” level. The highest mean of occupational stress was related to the subscale of “Role Overload” (36.30 ± 6.98) and the lowest mean was related to the subscale of “Physical Environment” (33.58 ± 9.76). There was no statistically significant difference between the mean occupational stress and variables of sex, age, academic degree and working experience.

Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment

Background and aim:

The study aims at identifying the antecedents and consequences of emotional exhaustion in health professionals and, particularly, examining the process that leads from a hindrance demand, like role ambiguity, to exhaustion and job satisfaction. Emotional exhaustion is a phenomenon that affect health professionals with negative consequence on job satisfaction, and literature has underlined that job demands could be may be a cause of this chronic stress. However, the relationship among job demands, work engagement and exhaustion has produced results not always converging.

Method:

A self-report questionnaire was administered to 66 health professionals.

Results:

The results showed that the effect of role ambiguity on emotional exhaustion was mediated by work engagement and the emotional exhaustion impairs job satisfaction when workers are not committed to their profession.

Conclusions:

Role ambiguity represents a psychosocial risk factor that influence workers’ wellbeing diminishing the level of motivation and this process leads to emotional exhaustion. However, professional commitment appears to be a resource that can protect professionals preventing a decrease in satisfaction. These findings suggest that human resource management should remove hindrance stressors and enhance the mission of Healthcare Professionals in order to increase employees’ work engagement and prevent exhaustion. (www.actabiomedica.it)

Gender assessment of job stress in healthcare workers. Implications for practice

Background:

Work-related stress (WRS) in the healthcare sector is a major issue for both workers and organizations. To date, no consensus exists regarding differences in gender susceptibility to WRS in healthcare workers (HCWs).

Objectives:

The purpose of this study was to analyze how male and female HCWs employed in emergency departments experienced WRS.

Methods:

A cross-sectional study was conducted regarding the perception of WRS in registered nurses employed in emergency departments. The Italian version of the Job Content Questionnaire and the Rapid Stress Assessment scale were administrated to 710 registered nurses.

Results:

The WRS assessment showed that significantly more females than males were in a situation of isostrain (18.5% vs 9.8% p<0,05). In females, low social support was associated with high levels of job strain (18,5% vs 4,4% p<0,05).

Conclusion:

This study reflects the need for a gender-specific approach in the evaluation of WRS in the healthcare sector, and is consistent with literature that evidenced gender differences in the perception of WRS. Lack of social support proved to be a determinant of WRS in female HCWs. Organizational interventions aimed at providing a more suitable workgroup design are required in order to minimize WRS in female HCWs.

Organizational Factors and Burnout of Perioperative Nurses

BACKGROUND

Knowing the organizational factors that predict burnout in perioperative nurses is paramount for improving the care of patients and promoting nurses' psychosocial well-being and health.

OBJECTIVE

To determine the influence of organizational factors of the perioperative nurse's work environment on the three burnout dimensions: emotional exhaustion, despersonalization, and personal accomplishment.

METHOD

A cross-sectional study was conducted among 136 nurses in a perioperative care unit at a university hospital in Barcelona, Spain. Data were collected using a demographic data form, and the Spanish versions of the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory.

RESULTS

Findings showed emotional exhaustion in 43% (56) of nurses, depersonalization in 21% (28), and reduced personal accomplisment in 53% (69). The degree of general burnout was moderate.The work environment was considered unfavourable as only one factor of five was favourable (Nursing foundations of quality care). Multiple regression analyses showed three organizational factors were associated with all three dimensions of burnout: "Nurse manager ability, leadership, and support of nurses"; "Staffing and resources adequacy"; and "Nursing foundations of quality care".

CONCLUSIONS

In this study three organizational factors played a significant role in predicting burnout among perioperative nurses. We recommend hospital management implement policies to improve these organizational factors. Promoting positive leadership styles, providing necessary resources, and creating a positive climate in the work environment could increase psychosocial wellbeing and decrease burnout among perioperative nurses.

Wellness room as a strategy to reduce occupational stress: quasi-experimental study

OBJECTIVE

To compare occupational stress levels of nurse staff working in the surgical unit before and after the intervention "wellness room".

METHOD

Quasi-experimental study with a sample of 60 nurse staff working in a surgical unit of a teaching hospital in the Southern Region of Brazil. The intervention was conducted in a room in the workplace for six months and consisted of sections of aesthetic care, relaxation, lectures and workshops to reduce occupational stress. Data were collected through the Demand-Control-Support Questionnaire before and after the intervention, and the comparative analysis was performed by the Wilcoxon test.

RESULTS

After the intervention, there was a decrease in demand and an increase in control and in the social support received at work in all professional categories, but the differences were not statistically significant.

CONCLUSION

The intervention "wellness room" reduced occupational stress levels in the sample studied; however, it was not a significant decrease.

Moderating effects of coping on work stress and job performance for nurses in tertiary hospitals: a cross-sectional survey in China

Background

Work stress is a major problem for nurses and it can negatively influence job performance. Therefore, it is critical to explore variables that can reduce or buffer the negative effects of work stress. This study explores the moderating effects of coping strategies on the relationship between work stress and job performance for nurses in China.

Methods

A cross-sectional survey of 852 nurses from four tertiary hospitals in Heilongjiang Province, China, was conducted in 2013. Descriptive statistics were reported for socioeconomic status and demographic characteristics, level of work stress, coping strategies, and job performance. Regression analysis was conducted to test the interaction between work stress and coping strategies on job performance.

Results

Three subscales of work stress were negatively related to job performance. Positive coping strategies moderated Patient Care and job performance while negative coping strategies moderated Workload and Time and performance, and between Working Environment and Resources and performance.

Conclusions

Positive coping strategies reduce or buffer the negative effects of work stress on job performance and negative coping strategies increased the negative effects.

Predictors of occupational burnout among nurses: a dominance analysis of job stressors

AIMS AND OBJECTIVES

To quantitatively compare dimensions of job stressors' effects on nurses' burnout.

BACKGROUND

Nurses, a key group of health service providers, often experience stressors at work. Extensive research has examined the relationship between job stressors and burnout; however, less has specifically compared the effects of job stressor domains on nurses' burnout.

DESIGN

A quantitative cross-sectional survey examined three general hospitals in Jinan, China.

METHOD

Participants were 602 nurses. We compared five potential stressors' ability to predict nurses' burnout using dominance analysis and assuming that each stressor was intercorrelated.

RESULTS

Strong positive correlations were found between all five job stressors and burnout. Interpersonal relationships and management issues most strongly predicted participants' burnout (11·3% of average variance).

CONCLUSION

Job stressors, and particularly interpersonal relationships and management issues, significantly predict nurses' job burnout.

RELEVANCE TO CLINICAL PRACTICE

Understanding the relative effect of job stressors may help identify fruitful areas for intervention and improve nurse recruitment and retention.

Job stress and burnout: A comparative study of senior and head nurses in China

Senior nurses can suffer from high job stress and burnout, which can lead to negative patient outcomes and higher turnover rates; however, few studies have examined this topic. We recruited 224 head and senior nurses from September to December 2015 using convenience and cluster sampling, to compare job stress and burnout levels between the two groups. The Nurse Job Stressors Inventory and Maslach Burnout Inventory scales were used to evaluate job stress and burnout, respectively. Results indicated that job stress scores significantly differed between head and senior nurses. The highest scoring subscales in both groups were time allocation and workload problems. Scores for the three burnout dimensions also significantly differed between the groups. Positive correlations between job stress and burnout were stronger among senior nurses than head nurses. Burnout may be higher among senior nurses given head nurses' potential for greater perceived job control. Our findings suggest that measures need to be taken to reduce burnout and turnover rates among senior nurses.

Quality of life and its influence on clinical competence among nurses: a self-reported study

AIM AND OBJECTIVE

This study aimed to investigate the quality of life and its influence on self-reported clinical competence among nurses.

BACKGROUND

Over the years, various studies have focused on the competence of nurses in clinical settings, indicating the paramount importance placed on ensuring superior levels of competence among nurses. The nature of the work in this profession is both stressful and challenging, which can pose a threat to the nurses and may impact their quality of life. Low quality of life may affect the quality of services that nurses are duty bound to provide to their patients.

METHODS

A convenience sample of 163 staff nurses was surveyed in this descriptive, cross-sectional study using the RAND 36-Item Health Survey 1·0, and the Nurse Competence Scale, with which to gather the data. Multivariate multiple regression and stepwise multiple linear regression analyses were conducted to examine the relationships among variables.

RESULTS

A majority of the respondents were married, females, holding a bachelor's degree and with ≥7 years of clinical experience. The respondents reported the highest mean score for quality of life in the 'role limitation due to emotional problems' dimension, whereas 'vitality' dimension received the lowest. A very good competence in all the categories measured for clinical competence was also reported. 'Managing situation' received the highest score among the dimensions of clinical competence, whereas 'ensuring quality' received the lowest. Number of years of clinical experience, educational level, marital status, 'role limitation due to emotional problems', 'emotional well-being', 'social functioning' and 'physical functioning' were identified as key factors that were likely to influence clinical competence.

CONCLUSIONS

Improved quality of life may possibly affect the level of competence of staff nurses.

RELEVANCE TO CLINICAL PRACTICE

Ensuring good quality of life among nurses is underscored. Efforts to enhance quality of life of nurses should be initiated to ensure high quality of care. Resultant findings should be taken into account by nurse managers when planning programmes and activities for improvement of competence among nurses.

Effort-reward imbalance and organisational injustice among aged nurses: a moderated mediation model

AIM

To test the effort-reward imbalance model among older nurses, expanding it to include the moderation of overcommitment and age in the stress-health complaints relationship, mediated by organisational injustice.

BACKGROUND

The theoretical framework included the effort-reward imbalance, the uncertainty management and the socio-emotional selectivity models.

METHOD

Employing a two-wave design, the participants were 255 nurses aged 45 years and over, recruited from four large hospitals in Spain (Madrid and Basque Country).

RESULTS

The direct effect of imbalance on health complaints was supported: it was significant when overcommitment was low but not when it was high. Organisational injustice mediated the influence of effort-reward imbalance on health complaints. The conditional effect of the mediation of organisational injustice was significant in three of the overcommitment/age conditions but it weakened, becoming non-significant, when the level of overcommitment was low and age was high.

CONCLUSIONS

The study tested the model in nursing populations and expanded it to the settings of occupational health and safety at work.

IMPLICATIONS FOR NURSING MANAGEMENT

The results of this study highlight the importance of effort-reward imbalance and organisational justice for creating healthy work environments.