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

Promoting resilience in mental health nurses: A partially clustered randomised controlled trial

BACKGROUND

There is a critical global shortage of nurses in mental health, with workforce attrition due in large part to workplace stressors. Proactive strengths-based interventions to strengthen nurses' capacity to manage stress and improve mental health, wellbeing and resilience may also support workforce retention.

OBJECTIVE

To determine the effects of a resilience-building programme on mental health nurses' coping self-efficacy (primary outcome), and psychological distress, wellbeing, resilience, posttraumatic growth, emotional intelligence behaviours, workplace belonging, and turnover intention (secondary outcomes).

DESIGN

Partially clustered randomised controlled trial.

SETTING

Large tertiary metropolitan mental health service in Australia.

PARTICIPANTS

A total of 144 registered and enrolled nurses working clinically ≥0.6 full-time equivalent (73/intervention, 71/control), with 122 completing 3-month follow-up.

METHODS

The Promoting Resilience in Nurses programme is an evidence-based workplace intervention delivered by trained facilitators across two workshops. Surveys were administered online upon registration and prior to randomisation (Time 1) into Intervention or Control (no intervention) arms, and immediately after the final workshop (Time 2), and at three months follow-up (Time 3). Linear mixed models for outcome measures were fitted to Time 2 and 3 responses.

RESULTS

There were seven intervention groups, with seven to 13 participants per group. Coping self-efficacy improved at Time 2 (estimated intervention effect 21.2 units, 95 % Confidence Intervals: 13.3 to 29.0) and Time 3 (12.1 units, 4.7 to 19.6), as well as wellbeing (Time 2: 9.2 units, 5.0 to 13.4), resilience (Time 2: 0.24 units, 0.01 to 0.46) and posttraumatic growth (Time 2: 16.1 units, 7.0 to 25.3). Psychological distress reduced (Time 2: -3.7 units, -6.2 to -1.31). All were sustained at three months. Emotional intelligence behaviours were improved (Time 2: 3.5 units, 0.6 to 6.5) but not sustained. Workplace belonging improved at Time 3 (0.34 units, 0.02 to 0.65) only. No statistically significant effects for turnover intention.

CONCLUSIONS

Despite major contextual challenges, the Promoting Resilience in Nurses programme achieved the aims of promoting nurses' efficacy to cope with stress and regulate their emotions and improving mental health and wellbeing. The findings support the programme as a feasible and successful intervention for nurses across other settings and contexts.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12620001052921). Registered 15/10/2020. First recruitment 04/02/2021.

TWEETABLE ABSTRACT

Promoting Resilience in Nurses intervention improved coping self-efficacy, wellbeing, resilience, posttraumatic growth, emotional intelligence and psychological distress.

Effect of occupational stress and resilience on insomnia among nurses during COVID-19 in China: a structural equation modelling analysis

OBJECTIVES

To explore the effects of occupational stress and resilience on insomnia among Chinese nurses during the COVID-19 pandemic.

DESIGN, SETTINGS AND PARTICIPANTS

A quantitative description study. The data were collected via a cross-sectional survey. A total of 725 front-line nurses at three tertiary hospitals in western China were included from December 2022 to January 2023. The Connor-Davidson Resilience Scale, Job Content Questionnaire, and Athens Insomnia Scale were used to collect data from a self-reported online questionnaire.

OUTCOME MEASURES

The outcome variable was insomnia, and structural equation modelling was used to assess the associations among resilience, occupational stress and insomnia.

RESULTS

The prevalence of insomnia among the participants was 58.76%. The structural equation model showed that resilience had a negative direct effect on insomnia and occupational stress, and occupational stress had a positive direct effect on insomnia. Involvement in COVID-19-related work has a positive effect on insomnia through occupational stress. In contrast, higher education levels improved insomnia through increased resilience.

CONCLUSION

A significantly higher prevalence of insomnia has been observed among Chinese nurses during the COVID-19 pandemic. Our study suggests that better resilience may improve insomnia by relieving occupational stress, and implementing measures to promote resilience is essential to reduce occupational stress in nurses and improve their sleep quality.

The nurse bombarded, consumed and vulnerable: An interpretative phenomenological analysis of mental health nurses' self-care at work

INTRODUCTION

Self-care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self-care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self-care practices is essential. There is currently a paucity of literature on this topic.

AIM

To explore mental health nurses' views about what influences their ability to self-care in relation to workplace stress and the impact on their practice and work environment.

METHODS

An Interpretative Phenomenological Analysis approach was utilized. In-depth interviews explored how nurses perceived the influence of environment and relationships on self-care practices in the workplace.

RESULTS

Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes-the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care.

CONCLUSIONS

Stressful working environments pose major barriers to effective self-care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally.

IMPLICATIONS FOR PRACTICE

Mental health nurses' self-care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self-care are therefore necessary.

The Relationship between Burnout and Wellbeing Using Social Support, Organizational Justice, and Lifelong Learning in Healthcare Specialists from Romania

Background and objectives: The goal of this study was to evaluate the levels of organizational justice, social support, wellbeing, and lifelong learning associated with the level of burnout experienced by medical and non-medical staff from public and private medical units. Materials and Methods: A cross-sectional study was conducted on a sample of 497 healthcare professionals: 367 medical personnel (M_age = 43.75 ± 0.50), including 216 nurses, 97 physicians, and 54 respondents with other medical specialities such as biologists, psychologists, physical therapists, pharmacists, etc., and 130 non-medical staff respondents (M_age = 45.63 ± 0.80), including administrative personnel. The Maslach Burnout Inventory, the ECO System, the Multidimensional Scale of Perceived Social Support, the WHO Wellbeing Index, and the revised Jefferson Scale of Physician's Lifelong Learning were used. Results: Burnout was measured in terms of emotional exhaustion, depersonalization, and personal accomplishment. Medical personnel registered higher values of personal accomplishment (38.66 ± 0.39 vs. 35.87 ± 0.69), while non-medical personnel registered higher values of depersonalization (6.59 ± 0.52 vs. 4.43 ± 0.26) and emotional exhaustion (27.33 ± 1.24 vs. 19.67 ± 0.71). In terms of organizational justice, higher scores were observed for medical staff, while non-medical staff recorded lower values (24.28 ± 0.24 vs. 22.14 ± 0.38). For wellbeing, higher scores were also registered for medical staff (11.95 ± 0.21 vs. 10.33 ± 0.37). Conclusions: For lifelong learning and social support, no statistically significant differences were found. In the case of the proposed parallel moderated mediation model, the moderated mediation effects of organizational justice, lifelong learning, and burnout on the relationship between social support and wellbeing were valid for every dimension of burnout (emotional exhaustion, depersonalization, and personal accomplishment), but lifelong learning was not found to be a viable mediating variable, even if high levels of social support correspond to high levels of lifelong learning and wellbeing.

The relationship between psychological resilience and professional quality of life among mental health nurses: a cross-sectional study

BACKGROUND

Mental health nursing is a demanding and stressful profession that impacts nurses' professional quality of life. Psychological resilience can be a protective factor. However, the relationship has not been extensively studied. This study aims to examine the relationship between psychological resilience and professional quality of life and identify potential predictors of ProQOL subscales among mental health nurses.

METHODS

The study employed a cross-sectional design to collect data from 179 mental health nurses. Data was collected using two standardized questionnaires: the Connor-Davidson resilience scale and the professional quality of life scale. Participants were recruited through convenient sampling during a 3-month period from April to June 2022, and the data were collected using an online survey tool called QuestionPro.

RESULTS

The study found a strong positive correlation between psychological resilience and compassion satisfaction (r = 0.632, P < 0.001). However, there was a negative significant correlation between resilience with burnout (r = -0.470, P < 0.001) and secondary traumatic stress (r = -0.210, P = 0.005). The study also found that higher resilience levels were associated with higher levels of compassion satisfaction and lower levels of secondary traumatic stress. Additionally, higher burnout scores were associated with higher levels of secondary traumatic stress. The study also identified that age and the number of children had weak associations with compassion satisfaction, while workplace was a significant predictor of burnout and secondary traumatic stress.

CONCLUSION

The study emphasizes the importance of resilience, burnout, and secondary traumatic stress in the well-being of healthcare professionals, especially nurses. The findings suggest that assessing nurses' resilience and professional quality of life can raise psychological resilience awareness and help managers create the necessary working conditions to improve nurses' professional quality of life.

Prevalência e Fatores associados ao Estresse Relacionado ao Trabalho e à Síndrome de Burnout entre Profissionais de Enfermagem que Atuam em Oncologia

Introdução: Os profissionais de enfermagem, ao considerarem o processo relacionado às condições de trabalho, estão expostos a situações que podem desencadear estresse relacionado ao trabalho e síndrome de burnout. Objetivo: Avaliar a prevalência e os fatores associados ao estresse relacionado ao trabalho e à síndrome de burnout entre profissionais de enfermagem atuantes em oncologia. Método: Estudo transversal realizado com 231 profissionais de enfermagem que atuavam em Centro de Alta Complexidade em Oncologia do Rio de Janeiro, RJ, Brasil. O estresse relacionado ao trabalho foi avaliado por meio da escala de estresse no trabalho e a síndrome de burnout pelo Maslach Burnout Inventory. A associação entre os desfechos e as variáveis independentes foi realizada por meio da Regressão de Poisson com variância robusta. Consideraram-se estatisticamente significativos valores de p<0,05. Resultados: A prevalência de estresse moderado/intenso relacionado ao trabalho foi de 75,8%, e de 38,9% para os profissionais que apresentaram síndrome de burnout. A idade, o histórico de acidente de trabalho e a agressão verbal e física estiveram positivamente associados ao estresse relacionado ao trabalho e à síndrome de burnout. Além disso, o estresse autorreferido foi fator de risco para essa síndrome. Conclusão: Observou-se alta prevalência de estresse relacionado ao trabalho e à síndrome de burnout, cujos desfechos estiveram associados à idade, ao histórico de acidente de trabalho e à violência laboral.

Resilience and mental health nursing: An integrative review of updated evidence

Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well-being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018-June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well-being, post-traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self-regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self-confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well-being, workforce sustainability and the ongoing impacts of the COVID-19 pandemic.

Prevalence and risk factors of sub-health and circadian rhythm disorder of cortisol, melatonin, and temperature among Chinese midwives

Objective

This study aimed to explore the influencing factors of sub-health and circadian rhythm disorder among midwives and whether circadian rhythm disorder was associated with sub-health.

Methods

A multi-center cross-sectional study was conducted among 91 Chinese midwives from six hospitals through cluster sampling. Data were collected by demographic questionnaire, Sub-Health Measurement Scale version 1.0, and circadian rhythm detection. Minnesota single and population mean cosine methods were used to analyze the rhythm of cortisol, melatonin, and temperature. Binary logistic regression, nomograph model, and forest plot were performed to identify variables associated with midwives' sub-health.

Results

There were 65 midwives with sub-health and 61, 78, and 48 midwives with non-validation of circadian rhythms of cortisol, melatonin, and temperature among 91 midwives, respectively. Midwives' sub-health was significantly related to age, duration of exercise, weekly working hours, job satisfaction, cortisol rhythm, and melatonin rhythm. Based on these six factors, the nomogram was presented with significant predictive performance for sub-health. Furthermore, cortisol rhythm was significantly associated with physical, mental, and social sub-health, whereas melatonin rhythm was significantly correlated with physical sub-health.

Conclusion

Sub-health and circadian rhythm disorder were generally common among midwives. Nurse administrators are supposed to pay attention and take measures to prevent sub-health and circadian rhythm disorder among midwives.

A Phenomenological Understanding of Mental Health Nurses' Experiences of Self-Care: A Review of the Empirical Literature

Nurses are central to health care as the largest professional workforce and the providers of constant, ongoing care. Difficulties retaining enough qualified and motivated nurses presents an ongoing problem that threatens the quality of healthcare delivery. Demands of nursing practice, often resulting in stress and burnout, is a major barrier to retaining nurses. Self-care approaches and techniques have proven effective in reducing stress and burnout, increasing job satisfaction and the likelihood of nurses remaining in the profession. Despite knowing the benefits, nurses frequently do not engage in self-care resulting in negative consequences both personally and professionally. To advance our knowledge in this important area, a review of the literature was conducted to explore nurses' experience of self-care and how they made sense of their experiences. The literature was analysed critically and synthesised through a phenomenological lens. The identified themes were structured according to phenomenological concerns: selfhood, mood and embodiment, sociality and relatedness, temporality, spatiality, and nursing culture. Understanding self-care from a phenomenological perspective is important to forming a deeper comprehension of nurses' relationship with self-care, including acceptance and resistance. This new knowledge can be used to develop strategies to encourage self-care. The implications for recruitment and retention within nursing, and ultimately to the quality of healthcare, are significant.

Burnout and coping strategies among nurses in Malaysia: a national-level cross-sectional study

OBJECTIVE

This national-level study aimed to determine the prevalence and risk factors of burnout, as well as the coping strategies among nurses in the Ministry of Health (MOH) Malaysia.

DESIGN

Using a complex sampling design, a two-stage stratified cluster sampling was performed to recruit MOH nurses between August and November 2019.

SETTING AND PARTICIPANTS

A total of 2428 nurses from 32 hospitals and 28 district health offices answered the questionnaires based on Maslach Burnout Inventory for Human Services and Brief COPE. Complex sampling analysis was applied.

OUTCOME MEASURES

The outcome of interest was the prevalence of burnout and its three domains of emotional exhaustion (EE), depersonalisation (DP) and low personal accomplishment. ORs using 95% CIs were calculated. Significant factors at the univariate level were entered into the multivariate logistic regression to identify independent predictors of burnout.

RESULTS

One in four (24.4%) nurses experienced burnout. Younger, single, and childless nurses had a higher prevalence of burnout. Shift working nurses were 1.6 times more likely to develop burnout. Those who performed >6 night shifts per month were 1.5 times more predisposed to burnout (95% CI 1.01 to 2.36; p<0.05). While encountering traumatic events at work led to 4.2 times (95% CI 2.31, 7.63; p<0.05) higher risk of burnout, those who received post-traumatic psychological support were better protected. The use of dysfunctional coping strategies was detrimental as it was positively correlated with EE and DP.

CONCLUSION

Addressing modifiable stressors of burnout at individual and institutional levels identified in this study can be potentially beneficial in reducing burnout and its undesirable effects among nurses. Interventions that promote positive coping strategies should be implemented. Organisational-driven efforts must target the improvement of work schedules for nurses and the establishment of a structured debriefing service for post-trauma counselling.

The protective effect of grit on clinical nurses' occupational psychological distress: Mediating and suppressing effects of Hope

As at a high-risk group of psychological distress, nurses generally experience varying degrees of stress, anxiety, and depression. This paper identifies the positive factors that may negatively regulate the psychological pain of clinical nurses and their mechanisms of action, providing reliable references for clinical nurse support management. The effects and mechanisms of hope and the two components of grit consistency of interest and perseverance of effort) on clinical nurses' psychological distress (depression, anxiety, and stress) were observed in this study. A total of 635 Chinese clinical nurses (90.4% female) completed an anonymous questionnaire for the survey. As expected, hope, consistency of interest, and perseverance of effort were negatively correlated with the three indicators of psychological distress (r = -0.21 ~ -0.38, p < 0.01). Path analysis results showed that hope significantly mediated the negative effect of consistency of interest on psychological distress, with an effect of 12.96%. Hope also covered up the perseverance of effort on psychological distress, the effect of 110.63%. In the influence of consistency of interest and perseverance of effort on psychological distress, hope contributed a vital mediating. Based on these results, it can be concluded that grit and hope have protective effects on psychological distress in clinical nurses. Significantly increasing the level of hope or grit may effectively prevent and reduce psychological distress in clinical nurses.

Predictors burden in mental health workers during the COVID-19 pandemic

OBJECTIVES

to analyze burden predictors in mental health workers during the COVID-19 pandemic.

METHODS

a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score.

RESULTS

it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05).

CONCLUSIONS

working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.

Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study

Mental health nursing is acknowledged internationally as being a demanding profession; however, little is known about the range of experience and complexity of workplace challenges or their impacts on mental health nurses (MHN). This qualitative descriptive study aimed to examine and describe the range of challenging workplace situations experienced by MHN and is reported according to the Standards for Reporting Qualitative Research. An online cross-sectional survey collected demographic data and open-ended descriptions of workplace challenges experienced by n = 374 Australian MHN. Using a modified a priori framework, four categories of experience were derived through content analysis: consumer-related, colleague-related, nursing role-related, and organizational service-related challenges. Many accounts described a complex interplay of challenges. The findings extend prior knowledge on MHN experiences. Frequent workplace challenges included violence and aggression from consumers, bullying from colleagues, low staffing levels, and poor skill mix. Further extending the evidence, key challenges rarely described in prior literature were the psychological impacts of suicides and murder; the personal nature of threats from consumers; moral distress and concerns with colleagues' quality of practice; and exacerbation of practice-related issues by lack of support from colleagues and/or the organization. These have important implications for the profession and can inform targeted strategies to reduce stressors where possible, build staff well-being, support workforce retention, and improve the provision of quality care. The implementation of targeted policy and initiatives that focus on reducing key stressors and supporting practice are vital to staff retention and ensuring a high standard of practice in complex mental health workplaces.

Preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19

RESUMO Objetivos: analisar os preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Métodos: estudo quantitativo, coletado entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala de Avaliação da Sobrecarga de Profissionais em Serviços de Saúde Mental, em quatro serviços de um município do estado de São Paulo, Brasil, com 108 trabalhadores. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: evidenciou-se mediana sobrecarga de trabalho (2,03). Preditores: acompanhamento psicológico ou psiquiátrico; desempenho normal das atividades durante a pandemia; atuação direta com casos suspeitos ou confirmados de COVID-19; e pertencer ao grupo de risco (pessoas acima de 60 anos, diabéticos, hipertensos, cardiopatas, problemas respiratórios) (p<0,05). Conclusões: condições de trabalho observadas durante a pandemia, simultaneamente com necessidades de cuidado à saúde mental dos trabalhadores, predizem sobrecarga no trabalho em saúde.

Burnout in Mental Health Care Professionals Working with Inpatients in Open or Closed Wards in Psychiatric Hospitals

Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals.

Impact of nurses' emotional intelligence on the implementation of a professional practice model in cancer care

AIM

To examine the impact of emotional intelligence on the effective implementation of a professional practice model in a specialised cancer centre.

METHODS

The study used a cross-sectional design with 580 frontline nurses at King Hussein Cancer Center, Jordan. The sample was selected using a convenience sampling technique. Data were collected using two self-administered questionnaires to measure emotional intelligence and professional practice.

RESULTS

The overall mean value of emotional intelligence was 5.60 out of 6 (SD=0.78), while the overall mean value for the implementation of the professional practice model was 4.76/5 (SD=0.59). The results showed that the overall mean value of emotional intelligence had a significant positive correlation with the effective implementation of the professional practice model (r=0.580, P<0.001), even after adjusting for the participants' demographics (P<0.001).

CONCLUSION

Emotional intelligence can be considered a predictor for the effective implementation of a professional practice model.

Decider Life Skills training as a method of promoting resilience with mental health student nurses on clinical placement

AIM

The aim of this study is to explore mental health student nurses' perceptions and application of a CBT-orientated training programme - the Decider Life Skills programme.

BACKGROUND

The undergraduate nursing degree programme is a challenging one and places high demands both professionally and personally on students. Mental health nursing students are faced with particular stressors including working with people in significant psychological distress, which can result in students feeling overwhelmed and emotionally burdened. There is a requirement for student nurses to be supported to cope with professional and personal difficulties while on practice placement. The Decider Life Skills is a one-day training programme that aims to build resilience and increase effective coping skills. This programme was offered to internship mental health nursing students with the aim of providing them with a toolbox of skills to maintain their wellbeing while on clinical placement.

METHODS

A qualitative descriptive design was used, and data were collected through two 45-min focus group interviews with mental health students (n = 10) on their internship placement. These students had received a one-day training in Decider Life Skills prior to their clinical placements. Full ethical approval was achieved for this study.

RESULTS

Participants reported that they found the skills imparted in the training easy to understand and apply in both their professional and their personal lives.

CONCLUSIONS

The findings from this study that the Decider Life Skills helped students cope in stressful situations and become more mindful of protecting their own mental health is important, as there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners.

Testing the relationship between patient-related stressor, psychological distress, work engagement, job satisfaction and recovery attitude among psychiatric nurses in Japan

AIMS

To test the relationship between patient-related stressor, psychological distress, work engagement and outcomes (job satisfaction and recovery attitude) among psychiatric nurses in Japan. Specifically, we tested the following hypotheses: psychological distress mediates the relationship between patient-related stressor and outcomes and work engagement moderates the direct and indirect effects of patient-related stressor on outcomes.

DESIGN

Cross-sectional study.

METHODS

In total, 446 psychiatric nurses in Japan responded to a self-reported questionnaire between August and October 2018. Data on demographics, patient-related stressor, job satisfaction, recovery attitude, psychological distress and work engagement were collected, followed by a moderated mediation analysis using hierarchical regression and structural equation modeling (SEM).

RESULTS

Regression analysis indicated that psychological distress mediated the negative relationship between patient-related stressor and job satisfaction and that work engagement moderated the direct and indirect effects of patient-related stressor on job satisfaction. In particular, the higher the work engagement, the higher the indirect effect, but the lower the direct effect. Additionally, no mediation of psychological distress and moderation of work engagement was observed in the relationship between patient-related stressor and recovery attitude; however, work engagement directly increased recovery attitude. Results of the SEM test showed a satisfactory fit of the final model.

CONCLUSIONS

Work engagement facilitates recovery attitude and increases the indirect effect of patient-related stressor on job satisfaction through psychological distress. However, work engagement decreases the direct effect not mediated by psychological distress.

IMPACT

This study addresses an essential topic, that is, psychiatric nurse job outcomes (job satisfaction and recovery attitude) are negatively influenced by patient-related stressor. Work engagement has multiple beneficial effects on outcomes as both a facilitator and moderator; thus, programs that improve work engagement are useful for psychiatric nurses. Furthermore, programs may be enhanced considering that work engagement decreases the direct effect of patient-related stressor on job satisfaction.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review

AIMS AND OBJECTIVES

The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work.

BACKGROUND

The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work.

DESIGN AND METHODS

The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed.

RESULTS

No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses.

CONCLUSION

To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work.

RELEVANCE TO CLINICAL PRACTICE

To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings

WHAT IS KNOWN ON THE SUBJECT?: There is a scarcity of studies concerning violence in psychiatric outpatient settings in the 2010s in spite of the deinstitutionalization of psychiatric services. Previous research on violence in psychiatric outpatient settings has failed to consider the association between the psychological consequences of violence, exposures to violence and background factors. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It has been known for some time that exposures to violence are harmful for psychiatric inpatient nurses; the paper demonstrates that psychiatric outpatient nurses are also at risk. The psychological consequences of exposure to violence are highly individualized and influenced by background factors. Nurses who face harassment have a greater risk of suffering psychological symptoms. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should consider the possibility of internal violence occurring when planning preventive interventions to manage and reduce workplace violence. Education targeted at violence prevention, management and debriefing should be organized systematically in psychiatric outpatient units and be taken into consideration in the mental health nursing curriculum. ABSTRACT: Introduction There is a scarcity of studies concerning violence and its consequences in psychiatric outpatient setting. Aim This study aimed to explore the occurrence of workplace violence and the psychological consequences of exposure to violence among nurses working in psychiatric outpatient settings. Method Research followed a cross-sectional survey design. Data were collected with the VIA-Q instrument. Results During the 12 months prior to the study, nurses (n = 181) had most often experienced psychological violence, with fatigue being the most common consequence. Harassment most often caused feelings of violated integrity, whereas physical violence most often caused insomnia. Significant relationships between exposure to violence and psychological consequences were identified. Discussion Workplace violence can manifest in a broad array of psychological symptoms and be harmful for nurses in psychiatric outpatient settings. It is important to discuss the subject of workplace violence and its place in the nursing curriculum and to reflect on how nurses are educated and trained to face violence in psychiatric nursing. Implications for Practice De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should take steps to abolish internal violence. Nurses need appropriate education in order to prepare them to manage workplace violence.

The Health Behaviour of German Outpatient Caregivers in Relation to Their Working Conditions: A Qualitative Study

Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the professional group of outpatient caregivers is highly relevant. Their work is characterised not only by interacting with patients in a mobile setting but also by working in shifts. Health behaviour under these specific working conditions is crucial for ensuring long-term work ability and performance. Little is known about the health behaviour of German outpatient caregivers and its potential impact on their work. The aims of the study were (1) to examine health behavioural patterns (nutrition, exercise, smoking, regeneration) of outpatient caregivers, (2) to illuminate their personal health-promoting behaviours, and (3) to identify potential work-related factors influencing their health behaviour. Fifteen problem-centred interviews were conducted with outpatient caregivers working in Northern Germany in the period January-April 2020. Interviews were analysed by using qualitative content analysis. Outpatient caregivers reported improvable nutrition and hydration, with simultaneous high coffee consumption, low physical activity, poor regeneration (breaks and sleep quality), and good personal health-promoting behaviour (e.g., back-friendly habits), although the majority were smokers. Barriers to the implementation of health-promoting behaviours were a high perception of stress due to increased workload and time pressure, while aids to better health-promoting behaviour were described as being social support and personal resources. The respondents perceived their working conditions as potentially influencing their health behaviour. On the basis of their descriptions, various practice-relevant strategies were derived. The data explore a potential need for outpatient care services to develop interventions on behavioural and structural levels that can help create healthier working conditions for their employees so these caregivers can adopt better health behaviours.

Mental health matters: A cross-sectional study of mental health nurses' health-related quality of life and work-related stressors

Mental health nursing is widely recognized as a stressful occupation; however, little is known about the relationship between work-related stress and health-related quality of life of mental health nurses (MHN). This study aimed to identify MHN health-related quality of life (HR-QoL) and work-related stressors; associations between stressors and HR-QoL; and predictors of HR-QoL. An online cross-sectional survey collected demographic data, work-related stressors and HR-QoL (SF-12v2) of n = 498 Australian MHN. Prominent consumer/carer-related stressors were verbal (90%) and physical aggression (85%). Collegial stressors included staff conflict (71%) and bullying (55%), and colleague-perpetrated verbal (34%) and physical aggression (7%). Key organizational stressors included high workloads (74%), lack of organizational support (60%) and lack of adequate resources to perform nursing role (58%). The mean physical health score was 52.62 (SD = 8.30), and mental health score was 43.59 (SD = 11.34), with mental health substantially lower than national norms (mean difference = 10.11). There were statistically significant negative correlations between the number of work-related stressors and HR-QoL. Younger (21-30 years) and less experienced (<1-4 years) MHN had substantially lower mental health. Higher mental health was predicted with < 15 stressors, >4 years' experience and working in the community. The poorer mental health of MHN has concerning implications for the well-being, retention and practice of the largest group in the mental health workforce. There is a critical need for organizations to enact effective policy and initiatives to reduce workplace aggression, improve staff psychological and physical safety, and strengthen well-being and resilience. New graduates are a priority group for urgent intervention.

Approaches to workload in psychiatric and mental health nursing

OBJECTIVE

to investigate approaches to workload in psychiatric and mental health nursing in Brazilian and international production of knowledge Methods: integrative literature review using six databases, covering January 2005 to March 2019. Articles in full in English, Spanish and Portuguese were included.

RESULTS

the sample consisted of 23 original articles classified as quantitative or emotional. The quantitative dimension was addressed in 12 articles and included: assessing patient care needs, identifying activities performed by the team, measuring time spent and developing and validating a measurement instrument. The emotional dimension included 11 articles the focus of which was on identifying stressors in the workplace, psychosocial risks and coping strategies.

CONCLUSION

strategies were found for measuring workload and assessing the impact of stressors on nursing teams.

Mindfulness, Compassion, and Self-Compassion as Moderator of Environmental Support on Competency in Mental Health Nursing

This research explored the established relationship between environmental support and competency for Mental Health Nurses, intending to investigate whether the tendency to display higher levels of mindfulness, compassion, and self-compassion might buffer the effect of a poor environment on competency. One questionnaire was comprised of five pre-developed questionnaires, which included all items examining environmental support, competency, mindfulness, compassion, and self-compassion. Mental Health Nurses (n = 103) were recruited from online forums and social media group pages in the UK. The result showed environmental support related positively to competency. Furthermore, the positive relationship of competency with environmental support was moderated when controlling for compassion but did not with mindfulness and self-compassion, although subscales showed some further interactions. When poor environmental support influences the competency of mental health professionals, compassion and mindfulness-based interactions may have the potential to uphold competency.

Stressoren, Stresserleben und Stressfolgen von Pflegekräften im ambulanten und stationären Setting in Deutschland

Dieser Beitrag liefert einen Überblick über den aktuellen Forschungsstand zu arbeitsbedingtem Stress in der ambulanten und stationären Pflege. Dabei wird auf Stressoren (z. B. Zeitdruck) und das Stresserleben, ebenso wie auf kurz- und langfristige Folgen von Stress (z. B. emotionale Erschöpfung und Burnout) in der Pflegebranche eingegangen. Des Weiteren werden Möglichkeiten zum Umgang mit Stress und zur Gesundheitsförderung von Pflegekräften beleuchtet. Im Ausland wurden bisher mehr Studien zu arbeitsbedingtem Stress unter Pflegekräften, insbesondere zu Burnout als Folge von Stress, durchgeführt als in Deutschland. Vor dem Hintergrund aktueller struktureller Herausforderungen für die Pflegebranche zeigt sich ein dringender Forschungsbedarf bezüglich der Arbeits- und Gesundheitssituation von ambulant und stationär tätigen Pflegekräften in Deutschland.

Prevalence of burnout among nurses working at a psychiatric hospital in the Western Cape

Background

Nurses are exposed to stress when working in the mental health care environment. This may be because of nurses being frontline health care providers. They develop close interpersonal relationships with mental health care users (MHCUs), which is inherent in the type of care that is provided. Mental health nursing may therefore be demanding and stressful, which could render mental health nurses susceptible to burnout.

Objectives

To determine the prevalence of burnout among nurses working at a selected psychiatric hospital in the Western Cape.

Methods

A quantitative, descriptive, survey design, by using simple random sampling was used to select 198 nurses employed at a psychiatric hospital in the Western Cape, South Africa. Maslach Burnout Inventory-Human Services Survey measuring emotional exhaustion, depersonalisation and personal accomplishment was used to collect the data. Domain scores were calculated, and the influence of the demographic variables on the domains was tested with independent samples Kruskal–Wallis tests and Mann–Whitney U tests.

Results

The study had a 100% response rate. Most of the respondents experienced low emotional exhaustion, low depersonalisation and high personal accomplishment. Enrolled nursing assistants reported significantly higher emotional exhaustion than did the advanced psychiatric nurses and professional registered nurses. Respondents with more than 5 years of experience scored significantly higher in depersonalisation. No respondents met the criteria for burnout on all three domains.

Conclusion

Maintaining a safe working environment with adequate nursing staff is recommended. Strategies to prevent burnout in the future include the provision of resources and the promotion of open communication between staff and management.

Psychological Capital Mediates the Association between Job Stress and Burnout of among Korean Psychiatric Nurses

This study examined the mediating effect of psychological capital in the relationship between job stress and burnout of psychiatric nurses. The participants were 108 psychiatric nurses working in three psychiatric hospitals located in South Korea. Data were collected from 10 August to 15 September 2018 using self-report questionnaires. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple linear regression by IBM SPSS 24.0 program. In addition, a bootstrapping test using the SPSS PROCESS macro was conducted to test the statistical significance of the mediating effect. There was significant correlation between job stress, psychological capital, and burnout. Psychological capital showed partial mediating effects in the relationship between job stress and burnout. Job stress explained 29.7% of the variance in burnout, and the model including job stress and psychological capital explained 49.6% of the variance in burnout. The bootstrapping showed that psychological capital was a significant sub-parameter and decreased job stress and burnout (LLCI = −0.1442, ULCI = −0.3548). These findings suggest that psychiatric nurses’ burnout can be reduced by implementing various health care programs designed to increase psychological capital.

"We try our best to offer them the little that we can" coping strategies of Ghanaian community psychiatric nurses: a qualitative descriptive study

Introduction

Community psychiatric nurses work in extremely stressful environments with intense patient relationships as they try to prevent self-harm and manage aggressive behaviors. In order to improve their ability to manage the stressful work environments, community psychiatric nurses need to incorporate formal coping strategies into their daily work routines. With evidence-based coping strategies, community psychiatric nurses can effectively manage the stressful situations in their work environment to increase their work longevity. The purpose of this study was to explore the individual coping strategies currently used by community psychiatric nurses in practice in order to develop an intervention strategy for future implementation.

Methods

This was an exploratory qualitative study using an interpretative approach. A purposive sampling method was used to identify participants from the community psychiatric nurses in a region of Ghana. Participants were recruited and interviewed, guided by semi-structured questions, until saturation was reached. The interviews were audio-taped, transcribed verbatim, and analyzed thematically.

Results

A total of 13 participants, 10 women and 3 men ages 26 to 60 years, were interviewed for this study. From the inductive analysis, four coping themes emerged from the data including: 1) self-disguise, 2) reliance on religious faith, 3) self-motivation, and 4) reduction in the number of home visits. The participants described their work environment as stressful, almost to the point of overwhelming. In this regard, they identified the individual coping strategies as critical daily practices for self care to manage their high stress levels.

Conclusion

Individual coping strategies are often used by community psychiatric nurses in daily practice. The participants identified personal coping strategies as critical interventions to manage stress and to decrease their risk for burnout. However, community psychiatric nurses must develop.personal-mastery in various coping strategies to care for themselves, as well as motivate them despite the challenging working environment. The individual coping strategies adopted by community psychiatric nurses was not only helped them deliver care, but also protected their clients so people would not label them as 'mental patients.' Collectively, the four strategies reported in this study need to be developed into a cohesive and comprehensive intervention.

Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study

There is widespread recognition that workplace stress can have profound negative impacts on nurses' well-being and practice. Resilience is a process of positive adaptation to stress and adversity. This study aimed to describe mental health nurses' most challenging workplace stressors, and their psychological well-being, workplace resilience, and level of caring behaviours, explore the relationships between these factors, and describe differences in workplace resilience for sociodemographic characteristics. In a descriptive correlational study using convenience sampling, data were collected from N = 498 nurses working in mental health roles or settings in Victoria Australia via an online cross-sectional survey. Key findings included weak to strong (r = 0.301 to r = 0.750) positive relationships between workplace resilience with psychological well-being across all stressor categories (consumer/carer; colleague; organizational role; and organizational service). Psychological well-being was moderately high, but lower for nurses indicating consumer/carer-related stressors as their most stressful challenge. There were weak to moderate (r = 0.306 to r = 0.549) positive relationships between workplace resilience and psychological well-being, and no relationship between resilience and caring behaviours. Workplace resilience was lower (P < 0.05) for less experienced nurses compared with those with >5 years' experience, and lower for younger nurses compared with those aged ≥40 years. To improve their resilience and prevent psychological distress, there is prime opportunity to support nursing students with well-being and resilience-building strategies during their undergraduate education, and to support new graduates with similar programmes when they enter the workforce.

Positive Orientation and Strategies for Coping with Stress as Predictors of Professional Burnout among Polish Nurses

Background: A psychological resource, positive orientation, may moderate stress and protect nurses from burnout. The purpose of this study was to determine the role of positive orientation and stress-coping strategies in predicting professional burnout among Polish nurses. Methods: A total of 1806 nurses employed in 23 hospitals in northeastern Poland participated in the study. The study used a standardized Positive Orientation Scale, Mini-COPE, and the Copenhagen Burnout Inventory. Results: On the stenographic scale, 21.8% of nurses had high levels of positive orientation, 46.8% were average, and 31.9% had low positive orientation. A total of 21.1% of respondents reported personal burnout. Most nurses reported work-related burnout (27%) and burnout in contacts with patients (28.4%) With increasing levels of positive orientation, nurses more often used adaptive strategies that focus on a problem and emotions. Personal burnout accounted for 16% of the variance of the dependent variable (β = −0.32; R² = 0.16), which was slightly lower than work-related burnout (10% (β = −0.23; R² = 0.10)), and burnout in contacts with patients (9% (β = −0.22; R² = 0.09)). Conclusion: The reduced level of positive orientation proved to be the main determinant of the professional burnout of Polish nurses. Burnout-prophylactic programs should be geared towards developing individual psychological resources, including positive orientation and the acquisition of effective stress-coping skills.

Mediating effects of self-efficacy, coping, burnout, and social support between job stress and mental health among young Chinese nurses

AIMS

To examine the mediating effects of self-efficacy, coping, burnout, and social support in the link between job stress and depression and anxiety among young Chinese nurses.

DESIGN

A cross-sectional survey was used.

METHODS

Full-time young nurses (N = 1,029) who worked in nine tertiary grade A hospitals in Chengdu China were recruited from December 2016-March 2017. Structural equation modelling was applied to analyse the mediating effects.

RESULTS

Job stress had a direct positive effect on anxiety (β = 0.054) and it also exerted indirect positive effects on depression (β = 0.337) and anxiety (β = 0.325) through mediating factors. Emotional exhaustion and social support were the main mediating variables, accounting for 72.0% of the variation in anxiety and nearly 43.4% in depression.

CONCLUSION

Emotional exhaustion and social support may have significant mediating effects in the link between job stress and depression and anxiety. Strategies including deceasing emotional exhaustion, enhancing social support in work environment, and reducing job stressors would be useful to prevent depression and anxiety among young nurses.

IMPACT

What problems did the study address? Depression and anxiety have great impact on professional performance of nurses and even patient safety. Factors such as coping, burnout, etc., may have different mediating effects in the paths from job stress to depression and anxiety. What were the main findings? Job stress had direct and indirect positive effects on anxiety and it only had indirect positive effect on depression. Emotional exhaustion and social support were the main mediating variables in the link between job stress and depression and anxiety. Where and on whom will the research have impact? Nursing managers should be more cognizant of the impact of job stress on the development of depression and anxiety. The significant mediating effect of emotional exhaustion and social support in the link between job stress and depression and anxiety should be emphasized by nursing administrators and effective targeted measures need to be adopted.

Prevalence of burnout in mental health nurses and related factors: a systematic review and meta-analysis

The aim of this study was to determine the prevalence of burnout in mental health nurses and to identify its predictors. A systematic review was conducted of studies published in the following databases: CINAHL, Dialnet, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus. The search equation used was "Nurs * AND Burnout AND mental health". Subsequently, three fixed-effects meta-analyses were performed, one for each dimension of burnout, to calculate its prevalence and the corresponding confidence intervals. The data were analysed using StatsDirect meta-analysis software. Eleven studies were finally included (n = 11). In most cases, the literature informs about moderate levels of emotional exhaustion, depersonalization, and personal accomplishment. The studies inform that variables such as work overload, work-related stress, professional seniority, male gender, being single, and aggression at work, among other factors, contribute to burnout development. The meta-analytic prevalence estimations of burnout with a sample of n = 868 mental health nurses are 25% for high emotional exhaustion, 15% for depersonalization, and 22% for low personal accomplishment. From a workforce development and safety perspective, it is important for managers to address the emotional exhaustion and low personal accomplishment aspects of burnout reported in the workplace by mental health nurses.

The correlation between occupational stress, coping strategies, and the levels of psychological distress among nurses working in mental health hospital in Jordan

PURPOSE

Psychiatric nurses encounter variety of demanding and stressful events such as dealing with aggressive patients, and hostile. This study purposed to assess workplace stress, coping strategies, and psychiatric distress among psychiatric nurses.

DESIGN AND METHODS

A descriptive explanatory design was employed. One hundred and nineteen psychiatric nurses were recruited in the study and data were collected in the period between June and September 2017.

FINDINGS

The results showed that participants experienced moderate level of occupational stress and psychiatric distress. In addition, they utilized different coping mechanism.

PRACTICE IMPLICATIONS

Stress management techniques program is very effective in helping psychiatric nurse to deal with occupational stress which might influence their wellbeing. Moreover, this program assists them to use more effective coping strategies as problem solving.

Resilience and mental health nursing: An integrative review of international literature

Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses' resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person-environment process. Resilience was most often reported as low-moderate, with positive correlations with hardiness, self-esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses' coping self-efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience-building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.

Violence committed against nursing staff by patients in psychiatric outpatient settings

Violence against nurses has increased particularly in psychiatric outpatient settings as psychiatric care shifts from being inpatient-based to being outpatient-based. Violence is a complex phenomenon that must be explored in different psychiatric nursing environments and settings. Violence in psychiatric outpatient settings should especially be explored as violence in this context has scarcely been examined. The aim of this systematic review was to elucidate violence committed against nursing staff by patients in adult psychiatric outpatient settings, based on reports from previous studies. A literature search was conducted in the CINAHL (EBSCO), Ovid MEDLINE, and PsycARTICLES (Ovid) databases. Fourteen studies emerged after the selection and quality assessment process. These studies indicated that violence in psychiatric outpatient settings is a multidimensional phenomenon comprising the reasons for, forms of, and consequences of violence. Reasons for violence could be related to the patient as well as to nursing staff. In psychiatric outpatient settings, verbal violence was the most common form of violence, and violence most frequently led to psychological consequences for nursing staff. The findings of this review highlight the importance of nursing staff developing skills and interventions for managing different kinds of violent situations. Given the multidimensional consequences of violence, attention must be given to the occupational well-being and coping ability of nursing staff at work. Furthermore, it would be worthwhile to compare cultural and intercountry differences of violent exposures in psychiatric outpatient settings.

Hospital Nurses in Comparison to Community Nurses: Motivation, Empathy, and the Mediating Role of Burnout

Background

Hospital nurses’ experience of their profession differs from that of community clinic nurses due to different working conditions and settings.

Purpose

To compare hospital nurses and community clinic nurses as to the mediating role of burnout on motivation and empathy.

Methods

In this cross-sectional study, 457 nurses completed four questionnaires: Demographic, Motivation Questionnaire, the Maslach Burnout Inventory, and the Toronto Empathy Questionnaire.

Results

Emotional exhaustion and depersonalization among hospital nurses were significantly higher than among community nurses. No significant differences were found in personal accomplishment, empathy, and motivation between the groups. Empathy and motivation were more strongly correlated among hospital nurses than among community nurses. Burnout was found to be a significant mediator between empathy and motivation in both groups but in each group by different burnout subscales.

Conclusions

To reduce burnout, leaders in the nursing field must enhance conditions in the hospital nurses’ work environment to lower levels of emotional exhaustion and depersonalization; community nurses should be guided to improve their attitudes toward their on-the-job performance to promote their personal accomplishment. Understanding the differences could direct policy makers’ desire toward enacting policies that accommodate these differences and focus on the needs of both groups of professionals.

Perceived job stress among community nurses: A multi-center cross-sectional study

AIM

China is reforming its health care system, which aimed to strengthen primary health care through building community health centers (stations) and assigning a "gate-keeper" role to primary care providers. Community nurses play a key role in the reform. Little is known about the level of job stress among community nurses. Thus, this study aims to explore the level of perceived job stress and its influencing factors among community nurses.

METHOD

A cross-sectional design was used to conduct a survey with 1015 nurses from 56 community health centers in Sichuan province. Job stress was measured by the Community Nurses Stress Scale. Data were collected between March and November 2015.

RESULTS

Community health nurses in China perceived high levels of job stress. The job stress was related to nurses' individual characteristics and work environments. Permanently employed nurses, shift workers, and those older than 45 years age and with less training related to community nursing and involvement in childcare were more likely to experience high levels of stress.

CONCLUSION

Reform is required of the community nursing personnel system, and development of continuing education programs and stress-alleviating measures to reduce community nurses' job stress. The results of this study favour future advanced practice community health nursing practice and education.

Burnout symptoms in forensic psychiatric nurses and their associations with personality, emotional intelligence and client aggression: A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Client aggression in forensic psychiatry is associated with burnout symptoms in nursing staff. It is unclear what mechanisms contribute to this relationship. The type and severity of aggression might be of importance in the association between client aggression and burnout symptoms, but also the personality characteristics and emotional intelligence of nursing staff. It is unknown whether wearable devices that measure arousal can be used to detect chronic stress and burnout symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Especially, physical aggression as experienced by nursing staff is associated with staff's burnout symptoms (e.g., emotional exhaustion and depersonalization). Further research on the aggression questionnaire is necessary. The stress management skill of nursing staff is an important factor to consider in the association between burnout symptoms and client aggression. The wearable device was not useful for detecting burnout symptoms. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing staff who experience (physical) aggression should be carefully monitored and should receive social support from their management to aid their well-being. Contrary to intuition, nurses who reported a higher number of stress management skills might have to be monitored more closely if necessary.

ABSTRACT

Introduction Aggressive behaviour of forensic clients is associated with burnout symptoms in nursing staff. The role of staff characteristics as moderators is unclear. Aim We explored the association between type and severity of aggressive behaviour as experienced by nursing staff and staff's burnout symptoms. In addition, the moderating roles of personality characteristics and emotional intelligence (EI) were studied. Moreover, the usefulness of ambulatory skin conductance assessments in detecting arousal related to burnout symptoms was studied. Method A total of 114 forensic nursing staff members filled out questionnaires and wore an ambulatory device. Results Experiencing physical aggression was positively associated with staff's burnout symptoms. Stress management skills, a subscale of EI, but not personality, moderated this relationship. Skin conductance was not associated with burnout symptoms. Remarkably, the association between aggression and burnout symptoms was highest for staff reporting a higher number of stress management skills. Discussion Longitudinal research is necessary to establish causality between client aggression and staff burnout symptoms. In addition, further research is necessary on the validity of the aggression measure used in the current study. Implication for practice Nursing staff who experience physical aggression frequently should receive social support for this, and staff who report high stress management skills should be monitored more carefully after having been confronted with aggression.

Occupational stress, coping strategies, and psychological-related outcomes of nurses working in psychiatric hospitals

AIMS

Psychiatric nurses experience a wide range of stressful events, evolving from the care of violent, aggressive patients, recurrent relapse, and poor prognosis of mental disorders. The aim of the study was to assess workplace stress, coping strategies, and levels of depression among psychiatric nurses.

METHODS

A descriptive correlation design was conducted on psychiatric nurses working in mental health settings Port-Said, Egypt. Data were collected from 70 nurses at a mental health hospital.

RESULTS

The results revealed that psychiatric nurses had moderate levels of work-related stress and depression, and exhibiting different coping strategies. Stress and depression are prevalent among psychiatric nurses.

CONCLUSIONS

Implementing programs aimed at teaching them how to deal with stress at work and improving their coping strategies and problem-solving skills are recommended.

Who supports the psychiatric nurse? A qualitative study of the social supports that affect how psychiatric nurses cope with workplace risks and stressors

The study focuses on how registered psychiatric nurses in a high-dependency unit in Ireland utilise informal and formal supports to cope with risk and trauma in the workplace, including threats of physical violence and verbal abuse. Increasingly, research and policy acknowledge that risk management and emotional trauma affect the workplace performance and general well-being of Registered Psychiatric Nurses. However, there is a paucity of Irish social scientific research on how psychiatric nurses negotiate informal and formal networks, to cope with workplace risks every day. Drawing on qualitative interviews, this paper ascertains how psychiatric nurses interpret everyday risks and how they draw upon support networks (e.g. family, co-workers) to cope with workplace stressors. The findings show that Registered Psychiatric Nurses who were interviewed create boundaries between informal and formal networks that help them to cope with workplace risks. Our study indicates that in this context, organisational supports are seldom used by Registered Psychiatric Nurses, even in times of crisis. A core contribution of the work is that it affirms the importance of co-workers in how Registered Psychiatric Nurses negotiate workplace risks and makes recommendations on how formal organisational supports might be improved.

Exploring the relationships among personality traits, burnout dimensions and stigma in a sample of mental health professionals

A sample of mental health professionals (n = 215) from six Community Mental Health Services was examined using a short version of the Attribution Questionnaire-27, the Maslach Burnout Inventory and the Ten Items Personality Inventory to detect possible associations among stigma, burnout dimensions and personality traits. The role of demographic and professional variables was also explored. Perception of workplace safety resulted to significantly affect attitudes toward patients. The concern about being assaulted and a low level of Personal Accomplishment were both related to avoidant attitudes, while the presence of procedures for managing the violent patient was associated with a higher level of Personal Accomplishment. Conversely, Emotional Stability and Openness to new experiences were inversely correlated with burnout dimensions and avoidant attitudes, respectively. Overall, our study supports the view of a significant association among some dimensions of stigma, burnout and personality factors. In particular, avoidant attitudes toward patients may be influenced by Personal Accomplishment and Openness to new experiences.

The Role of the Registered Nurse Working in Substance Use Disorder Treatment: A Hermeneutic Study

Substance Use Disorders (SUDs) are a national public health crisis. However, there is minimal existing research literature on the role of the nurse working in SUD treatment. The purpose of this study was to describe the meaning of the professional role of the registered nurse working in the SUD setting. The study utilized a Heideggerian Phenomenological approach with a modified Colaizzi method for analysis and interpretation. The nine study participants, two males and seven females, aged 27-60 had worked in SUD treatment for 1-37 years. Three major themes, with sub-themes, emerged: Defining the Role for Self; Learning the Role; and Navigating with Ease in an Unchangeable Culture. Findings demonstrated that nurses in SUD treatment value their role and the care of patients with SUDs. Patient recovery or relapse influenced job satisfaction. Significantly, the findings highlighted an outdated role with rigid boundaries and no real contemporary identity. Findings can be used to address the need for a contemporary SUD nursing identity and to support ongoing involvement of nurses in health policy related to SUDs.

Strengthening mental health nurses' resilience through a workplace resilience programme: A qualitative inquiry

WHAT IS KNOWN ON THE SUBJECT?: Mental health nurses are affected by interpersonal, practice-related and organizational factors that can increase workplace stress and reduce their physical and mental health and well-being. Resilience programmes are a strength-based preventative approach to supporting individuals to overcome workplace adversities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self-talk, managing negative self-talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social-ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well-being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. ABSTRACT: Introduction Mental health settings are potentially high-stress workplaces that can lead to nurses' poorer health and well-being. Resilience programmes are a strengths-based preventative approach for promoting mental health and well-being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim To explore the perspectives of mental health nurses participating in a mental health service-initiated resilience programme (Promoting Adult Resilience). Method An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open-ended responses and semi-structured interviews and focus groups, were thematically analysed. Results Twenty-nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self-efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice It is recommended resilience programmes are provided to promote nurses' well-being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well-being need to be addressed at a unit, organizational and professional level.

A cross-sectional study for the impact of coping strategies on mental health disorders among psychiatric nurses

Several studies report that psychiatric nursing is a highly stressful occupation. The ways that nurses use in order to deal with stressful situations have a serious effect on their psychological mood and their health status. The purpose of this study was to investigate the coping strategies in predicting of depression and anxiety among mental health nurses working in public psychiatric hospitals. A descriptive, cross-sectional study was conducted in Athens, Greece from April to May 2017. A questionnaire consisting of the socio-demographic and work-related characteristics, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder-2, and the 38-items Ways of Coping Questionnaire - Greek version, was completed by a total of 110 mental health nurses. Univariate and multivariate analyses were performed using the logistic regression model. Coping strategies focused on the problem (positive re-evaluation, positive approach, problem solving, and seeking social support) were the most commonly used by the mental health nurses. Strategies focused on emotion (prayer/daydream, prayer, avoidance/escape, resignation, and denial) were positively associated with depression and anxiety outcomes. Also, the coping skills of problem solving (Adjusted Odds Ratio, AOR=0.402), and seeking social support (AOR=3.719) were significant predictors only for elevated anxiety symptoms. The results from the study demonstrated the importance of coping behaviours in mental health problems of psychiatric nurses.

Well-being of nursing staff on specialized units for older patients with combined care needs

WHAT IS ALREADY KNOWN ABOUT THE SUBJECT

Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training.

ABSTRACT

Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown.

AIM

To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff.

METHOD

Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings.

RESULTS

Nursing staff across settings, with more than 5 years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work-related well-being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout.

IMPLICATIONS/CONCLUSION

Staff well-being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training.

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran

BACKGROUND

The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards.

DESIGN

A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data.

RESULTS

Four themes were developed based on the analysed data: "experiencing psycho-social challenges," "experiencing psychological challenges," "encountering catalysts causing challenges," and "employing various strategies for coping with challenges."

CONCLUSIONS

Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.

Shared trauma reality in war: Mental health therapists' experience

INTRODUCTION

Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions.

METHOD

Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress.

RESULTS

These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion.

DISCUSSION

These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.