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

Non-Qualified Staff's Experience of Suicidal Behaviour in Adult Mental Health Inpatient Services

Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for 'non-qualified' staff. This study explored experiences of suicide and attempted suicide on 'non-qualified' staff in AMHIS. Semi-structured interviews explored ten staff's experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; 'Direct personal impact', 'Unrealistic expectations', 'Attempting to contain the impact' and 'Acclimatisation'. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.

A Systematic Review of Job Demands and Resources Associated with Compassion Fatigue in Mental Health Professionals

Psychosocial hazards in mental healthcare contribute to the development of compassion fatigue in mental health professionals. Compassion fatigue has a negative impact on the mental health and wellbeing of professionals that can impair the quality of services provided to clients. The majority of research on compassion fatigue has focused on individual-level variables such as gender, history of trauma and age, among others. It is also imperative to understand the role played by alterable work-related characteristics in contributing to the development of compassion fatigue in order to attenuate its impact on mental health professionals and their clients. The present review examined articles exploring work-related factors associated with compassion fatigue. Fifteen quantitative studies were included and their quality was assessed using a checklist. An inductive content-analysis approach was adopted to synthesise the themes emerging from the data. The results suggested a theoretical model consistent with the Job Demands-Resources model, wherein job demands (such as workplace trauma, workload and therapeutic settings) are associated with compassion fatigue, and job resources (such as supervisors', coworkers' and organisational support) mitigate the impact of job demands. In addition to person-oriented factors, work-related factors are critical for the prevention of compassion fatigue.

Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants

This study aimed to estimate the level of burnout in mental health professionals and to identify specific determinants of burnout in this population. A systematic search of MEDLINE/PubMed, PsychINFO/Ovid, Embase, CINAHL/EBSCO and Web of Science was conducted for original research published between 1997 and 2017. Sixty-two studies were identified as meeting the study criteria for the systematic review. Data on the means, standard deviations, and prevalence of the dimensions of burnout were extracted from 33 studies and included in the meta-analysis (n = 9409). The overall estimated pooled prevalence for emotional exhaustion was 40% (CI 31%-48%) for depersonalisation was 22% (CI 15%-29%) and for low levels of personal accomplishment was 19% (CI 13%-25%). The random effects estimate of the mean scores on the Maslach Burnout Inventory indicate that the average mental health professional has high levels of emotional exhaustion [mean 21.11 (95% CI 19.98, 22.24)], moderate levels of depersonalisation [mean 6.76 (95% CI 6.11, 7.42)] but retains reasonable levels of personal accomplishment [mean 34.60 (95% CI 32.99, 36.21)]. Increasing age was found to be associated with an increased risk of depersonalisation but also a heightened sense of personal accomplishment. Work-related factors such as workload and relationships at work, are key determinants for burnout, while role clarity, a sense of professional autonomy, a sense of being fairly treated, and access to regular clinical supervision appear to be protective. Staff working in community mental health teams may be more vulnerable to burnout than those working in some specialist community teams, e.g., assertive outreach, crisis teams.

Nursing Staff Stress and Individual Characteristics in Relation to the Ward Atmosphere in Psychiatric In-Patient Wards

This study investigated the interplay between nursing staff stress, Mastery, Moral Sensitivity, individual characteristics and the ward atmosphere in psychiatric in-patient care. Data were collected through five questionnaires from 93 nursing staff. Multivariate analysis showed that Moral Strength, Moral Burden, Internal Demands, Perceived Stress and age were related to several factors of the ward atmosphere. We conclude that efforts to reduce stress levels and create a supporting ethical climate on psychiatric wards would be beneficial for both psychiatric nursing staff and their nursing practice.

Job Demands, Engagement, and Turnover Intentions in Polish Nurses: The Role of Work-Family Interface

Background: Poland has lower ratios of employed registered nurses per 1,000 inhabitants than the EU average. Polish nurses work under miserable conditions without assisting personnel, and they reconcile their professional demands with responsibilities for their families; 96% of them are women.

Rationale/Aims: This study uses Hobfoll’s conservation of resources (CORs) theory to explain the role of various resources in the improvement of work conditions in the nursing profession. Work-family conflict (WFC) and family work conflict (FWC) threaten to deplete nurses’ resources. This paper set out to (1) examine the extent to which perceived job demands (workload and interpersonal conflicts at work) and engagement (vigor, dedication, and absorption) are associated with turnover intentions (the intention to leave the present workplace and the intention to leave the nursing profession); (2) attempt to determine whether levels of WFC and FWC moderate these associations.

Design/Method: This study comprised 188 female registered nurses. The inclusion criterion was to live with a partner and/or have children.

Results: WFC was moderately related to FWC. Hierarchical regression analyses showed that only high job demands and low vigor were significantly associated with turnover intentions. WFC was experienced more intensively than FWC. Job demands, vigor, dedication, and turnover intentions had a strong effect on WFC, while absorption had a strong effect on FWC. However, levels of WFC and FWC did not significantly moderate these associations.

Originality/Conclusion: The study produces new knowledge by examining a constellation of job demands, work engagement and WFC, which reflect the management of personal resources. Results from such a constellation in nurses from countries with a post-transformational economic system have not previously been discussed in the light of COR theory. Most importantly, we conclude that WFC does not intensify turnover intentions.

Staff Burnout--a Comparative Study of Metropolitan and Rural Mental Health Nurses within Australia

This article will present the findings of a research study that investigated the extent to which mental health nurses employed within rural and metropolitan areas of Australia are affected by burnout, using the Maslach Burnout Inventory (MBI) and a demographic questionnaire. The study also examined whether the Maslach Burnout Inventory (MBI) was a valid measure of mental health burnout within the Australian context and culture or alternatively, in what ways it needed to be refined? A cross-sectional study of mental health nurses (n  =  319) from the states of New South Wales, Victoria, Queensland and Western Australia was undertaken. The 22-item Maslach Burnout Inventory (MBI) was used to measure burnout and a demographic questionnaire utilising a cluster sampling, cross-sectional design survey method, was used to gather the data. The study found that gender and level of qualification were the two major factors that showed any significance, where males experienced a higher level of depersonalisation on the frequency and intensity sub-scale scores of the MBI and that the more qualified a nurse, the greater the level of depersonalisation they experienced. These results were true for participants in both rural and metropolitan settings within Australia. Age was the third most influencing factor in terms of emotional exhaustion, where younger participants (under 30) reported higher levels of emotional exhaustion. Younger male mental health nurses experienced higher levels of depersonalisation.

Impact of a stress management program on stress perception of nurses working with psychiatric patients

Nurses caring for psychiatric patients may have to face violent emotions and unpredictable behaviour which can be quite stressful. A stress management program may equip nurses with skills to cope effectively with the stress. A one group pre-test and post-test design was adopted to test this hypothesis. Both gender nurses caring for psychiatric patients were invited to undergo 10 consecutive, one hour sessions of a stress management program. The DCL Stress scale (The De Villiers, Carson & Leary Stress Scale; Carson et al., 1997a,b,c) was used to collect data immediately after intervention and four weeks later. RM ANOVA with spss 16 showed that pre-intervention mean stress reduced significantly (p=0.000) from 57.45±16.42 to 41.06±16.51 immediately following the intervention and 26.43±12.82 (p=0.000) four weeks after the intervention. The stress management strategies positively impacted on nurses' stress levels.

Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care

The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.

Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals

Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care.

Staff engagement as a target for managing work environments in psychiatric hospitals: implications for workforce stability and quality of care

AIMS AND OBJECTIVES

To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals.

DESIGN

Cross-sectional survey.

BACKGROUND

A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff.

METHODS

A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions.

RESULTS

An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption.

CONCLUSION

The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

BACKGROUND

The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.

METHODS

93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.

RESULTS

The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.

CONCLUSIONS

The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Perceived stress among nursing staff in psychiatric inpatient care: the influence of perceptions of the ward atmosphere and the psychosocial work environment

The aims of this study were to investigate (1) perceived stress as felt by the nursing staff working in psychiatric inpatient care, (2) possible differences between nurses and nurse assistants, and (3) associations among individual characteristics, the ward atmosphere, the psychosocial work environment, and perceived stress. Ninety-three members of the nursing staff completed three instruments--one each measuring perceived stress, the ward atmosphere, and the psychosocial work environment. There were no differences among the staff groups concerning perceived stress. Multivariate analysis showed that the ward atmosphere factor "Involvement" and the psychosocial work environment factor "Role Clarity" were indicators of perceived stress. Improvements in these factors could help to prevent stress among the staff.