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Maddineshat M, Khodaveisi M, Kamyari N, Razavi M, Pourmoradi F, Sadeghian E. Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study. J Psychiatr Ment Health Nurs 2024; 31:257-269. [PMID: 37740710 DOI: 10.1111/jpm.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. AIM This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. METHOD An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. RESULTS The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. DISCUSSION MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. IMPLICATIONS FOR MENTAL HEALTH NURSING According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.
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Affiliation(s)
- Maryam Maddineshat
- Department of Nursing, School of Malayer Nursing, Student Research Committee, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Department of Community Health Nursing, School of Nursing and Midwifery, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammadreza Razavi
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | - Farnaz Pourmoradi
- Sina (Farchian) Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Efat Sadeghian
- Department of Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Kargin M, Aydin A. The experiences of Turkish psychiatric nurses with psychiatric emergencies in the clinics of Turkey's mental health and diseases hospital: A descriptive qualitative study. Perspect Psychiatr Care 2022; 58:39-46. [PMID: 34260750 DOI: 10.1111/ppc.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to describe the experiences of Turkish nurses in the psychiatry clinics of Turkey's Mental Health and Diseases Hospital DESIGN AND METHODS: This descriptive qualitative study was conducted on 20 psychiatric nurses working at a psychiatric hospital. A semi-structured in-person interview technique was used for data collection. RESULTS Six themes were defined in this study. The majority of psychiatric nurses stated that they usually faced suicidal and aggressive cases and that they used security measures, restraint and isolation, medical treatment, and emergency codes as basic interventions. PRACTICE IMPLICATIONS Psychiatry is a field of clinical practice requiring case management skills to deal with various psychiatric presentations.
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Affiliation(s)
- Maral Kargin
- Nursing Department, Faculty of Health Sciences, Cyprus Science University, Kyrenia, Cyprus
| | - Adeviye Aydin
- Nursing Department, Faculty of Health Sciences, Sinop University, Sinop, Turkey
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Rezaie L, Phillips D. Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:752-762. [PMID: 32277722 DOI: 10.1111/jpm.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A search of common databases indicates the absence of any research focused on the needs of Iranian women diagnosed with severe mental illness post-discharge from an inpatient setting. Moreover, there is a lacuna of information about the unique experiences and needs of persons diagnosed with severe mental illness living in non-Western communities (esp. Middle Eastern communities). WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study examined interviews of women diagnosed with severe mental illness receiving treatment at an Iranian inpatient hospital. Three categories of post-discharge needs emerged: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings highlight the need for systemic changes to current care models. Broadly, families should be incorporated into care to improve outcomes and decrease stigma. Regarding mental health nursing, results highlighted the need for additional nursing and occupational therapy interventions to empower families and patients. Nursing practitioners can aid in preparing these patients for employment and public health initiatives to decrease stigma and improve access to care. ABSTRACT: Introduction Understanding the post-discharge needs of patients diagnosed with severe mental illness is critical for improving treatment outcomes. Aim The aim of the present study was to determine the unique post-discharge needs of Iranian women diagnosed with severe mental illness. Method Conventional content analysis was utilized to analyse data gathered via focus group interviews conducted within the psychiatric inpatient unit at Farabi hospital located in Kermanshah, Iran. Participants (N = 42; M age = 40; SD = 6.3 years) had been diagnosed with a severe mental illness, had a history of at least two psychiatric hospitalizations and were awaiting discharge following significant symptom improvement. Results Content analysis extracted three categories of post-discharge needs: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. Discussion/Implications for practice Analysis of interview data highlighted the general need for adopting a family-system approach to reduce stigma, increase knowledge and foster skill acquisition. Regarding mental health nursing, results highlighted the unique role of nurses and their capacity to pre-emptively address needs such as aiding in employment. Lastly, findings are contrasted against Western care models.
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Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - David Phillips
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
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Tirgari B, Azizzadeh Forouzi M, Ebrahimpour M. Relationship Between Posttraumatic Stress Disorder and Compassion Satisfaction, Compassion Fatigue, and Burnout in Iranian Psychiatric Nurses. J Psychosoc Nurs Ment Health Serv 2019; 57:39-47. [DOI: 10.3928/02793695-20181023-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/23/2018] [Indexed: 11/20/2022]
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Vahidi M, Ebrahimi H, Areshtanab HN, Jafarabadi MA, West S, Foong A, Cleary M. Providing a Safe Environment in a Psychiatric Ward: Nurses and Vigilance in Iran. Issues Ment Health Nurs 2019; 40:65-72. [PMID: 30204026 DOI: 10.1080/01612840.2018.1463326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to explore nurses' use of vigilance in the provision of inpatient psychiatric care. In this qualitative exploratory descriptive design study, 16 nurses working in inpatient psychiatric units were recruited through purposive sampling. Data were collected by semi-structured interviews and fieldwork observations and analysed using conventional content analysis. According to participants, nurses' vigilance is related to synthesising knowledge, experience, communication, and presence. This conclusion was derived from four main themes: understanding the context of the psychiatric ward; continuous monitoring; cognitive assessments; and involving others. The study highlights the significance of education for all mental health staff and provision of appropriate information to all patients and their companions about psychiatric disorders and the side effects of prescribed medications. Of importance is the skill of active listening to the concerns of patients and the demonstration of commitment by nurses to follow-up on reports from stakeholders. Imparting the skills and experiences of senior nurses to novice nurses and their presence alongside other nurses on work-shifts can be effective in promoting vigilance.
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Affiliation(s)
- Maryam Vahidi
- a Department of Psychiatric Nursing, Faculty of Nursing and Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Ebrahimi
- a Department of Psychiatric Nursing, Faculty of Nursing and Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Namdar Areshtanab
- a Department of Psychiatric Nursing, Faculty of Nursing and Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Asghari Jafarabadi
- b Department of Statistics and Epidemiology, Faculty of Health Sciences , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Sancia West
- c School of Health Sciences , University of Tasmania , Sydney , Australia
| | - Andrew Foong
- c School of Health Sciences , University of Tasmania , Sydney , Australia
| | - Michelle Cleary
- c School of Health Sciences , University of Tasmania , Sydney , Australia
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Ramezani T, Gholamzadeh S, Torabizadeh C, Sharif F, Ahmadzadeh L. Challenges of Nurses' Empowerment in the Management of Patient Aggression: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:442-448. [PMID: 29184582 PMCID: PMC5684791 DOI: 10.4103/ijnmr.ijnmr_216_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients' aggression in the mental care setting is a global health problem with major psychological, physical, and economic consequences; nurse empowerment to manage this aggressive behavior is an important step in psychiatric nursing. The aim of this study was to explore psychiatric nurses' experiences of the challenges of empowerment in the management of patients' aggression. MATERIALS AND METHODS This qualitative study was performed among 20 nurses working in a major referral psychiatric center in Iran during 2014-2016. The purposive sampling method was used for selecting the participants. Data were collected through semi-structured interviews, observations, and filed notes. Inductive content analysis was used for data analysis. RESULTS Three categories and ten subcategories were identified: inefficient organizational policy (limited human resources, mandatory shifts, shortage of protective equipment, lack of motivational sparks); insufficient job growth (failure to implement training programs, insufficient effort for job competence, lack of clinical guidelines); and deficiencies in the organizational culture (inadequate autonomy and authority, lack of the culture of prevention, culture of fault and blame after an incident). CONCLUSIONS Psychiatric nurses were not satisfied with organizational empowering conditions for the management of patients' aggression and reported low levels of access to learning opportunity, receiving support and essential resources that led to unnecessary use of containment measures. Managers must make every effort to create organizational context that make it possible to empower nurses for optimal practice.
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Affiliation(s)
- Tahereh Ramezani
- Department of Nursing and Midwifery, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakineh Gholamzadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Faculty of Nursing and Midwifery School, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laaya Ahmadzadeh
- Research Center for Psychiatry and Behavior Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Salehi-Tali S, Ahmadi F, Zarea K, Fereidooni-Moghadam M. Commitment to care: the most important coping strategies among family caregivers of patients undergoing haemodialysis. Scand J Caring Sci 2017; 32:82-91. [PMID: 28524236 DOI: 10.1111/scs.12432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caregivers of patients undergoing haemodialysis often experience an intensive burden of care; therefore, it is important to understand the type of strategies that are used by caregivers to adapt and to commit themselves to caring for another individual. AIM The aim of this study was to explore the specific coping strategies used by family caregivers of patients undergoing haemodialysis. METHODS In this qualitative study, 16 family caregivers of patients undergoing haemodialysis were selected through purposive sampling in four dialysis centres in south of Iran. Semi-structured interviews were used to collect data. A content analysis of the interviews was performed to determine relevant themes. RESULTS Data analysis resulted in the emergence of four categories including 'cultural and religious constructs', 'sense of responsibility', 'self-restraint' and 'satisfactory caring', as whole of these categories are included in the main theme of 'commitment to care' which is experienced by the family caregivers during the care of patients undergoing haemodialysis. CONCLUSIONS This study demonstrates that coping strategies stemming from the cultural beliefs of caregivers are very salient in their commitment to care; thus, the health-care team, especially nurses, should encourage family caregivers to use these strategies to maintain their physical and psychological health and to provide quality care for patients.
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Affiliation(s)
- Shahriar Salehi-Tali
- Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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A study of stigma among Iranian family caregivers of patients with multiple sclerosis: A descriptive explorative qualitative study. Appl Nurs Res 2016; 34:1-6. [PMID: 28342617 DOI: 10.1016/j.apnr.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 05/25/2016] [Accepted: 11/19/2016] [Indexed: 11/24/2022]
Abstract
AIM This study was done to investigate the experiences of family caregivers of people with multiple sclerosis (MS) about stigmatization in Iranian health care context. BACKGROUND Stigmatization has been observed obviously among patients with MS but few studies have been conducted on stigma among the family caregivers of these patients. METHODS This qualitative study with thematic analysis was done to explore this issue. Fourteen family caregivers of patients with MS were selected by purposive sampling. The data were collected through in-depth and unstructured interviews. RESULTS Four main subthemes emerged from the analysis of the transcripts: "feeling shame", "fear of being ridiculed by others", "ignored by family" and "concealing disease to be secure against the perceptions of disease". CONCLUSIONS Healthcare professionals should be encouraged to inform caregivers about social engagement strategies and to train them on the management of stigma as an important factor for the reduction of their social problems.
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Sobekwa ZC, Arunachallam S. Experiences of nurses caring for mental health care users in an acute admission unit at a psychiatric hospital in the Western Cape Province. Curationis 2015; 38:1509. [PMID: 26842098 PMCID: PMC6091769 DOI: 10.4102/curationis.v38i2.1509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 09/11/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caring for mental health care users (MHCUs) with mental illnesses is a major task that confronts nurses globally. It has been argued that caring for this group of patients is accompanied by unique challenges. Despite the available abundance of data about nursing patients suffering from mental illnesses, little is known about the lived experiences of nurses who care for MHCUs in acute admission units in the Western Cape province. OBJECTIVES This study's aim is to explore and describe the lived experiences of nurses who care for MHCUs in an acute admission unit at a psychiatric hospital in the Western Capeprovince. METHODS A qualitative, descriptive, phenomenological study was conducted. A purposive sampling procedure was applied which resulted in a sample that comprised eight nurses. Indepth, individual, semi-structured interviews were conducted with these eight participants. Interviews were audio-recorded and transcribed verbatim and the researcher utilised Collaizzi's method to analyse collected data. RESULTS Both positive and negative experiences were reported. Positive experiences werethe recovery of patients, teamwork, and passion for caring. Negative experiences were thefeelings of being unappreciated and unsupported by authorities. Physical assault by MHCUs,shortage of staff, increased workload and burnout was also reported. CONCLUSIONS In-service training about management of aggression needs to be provided,debriefing sessions to deal with burnout needs to be arranged, and research to quantify levelsof burnout should be conducted.
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Mohtashami J, Rahnama H, Farzinfard F, Talebi A, Atashzadeh-Shoorideh F, Ghalenoee M. A Survey of Correlation between Professional Identity and Clinical Competency of Psychiatric Nurses. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.59080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hamzehgardeshi Z, Shahhosseini Z. Psychometric properties of an instrument to measure facilitators and barriers to nurses' participation in continuing education programs. Glob J Health Sci 2014; 6:219-25. [PMID: 25169003 PMCID: PMC4825514 DOI: 10.5539/gjhs.v6n5p219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/15/2014] [Accepted: 05/05/2014] [Indexed: 11/22/2022] Open
Abstract
Background: Continuing education programs are one of the professional principles in health-related disciplines, including nursing. The aim of this study was to develop an instrument measuring facilitators and barriers to nurses’ participation in continuing education programs. Methods: In the first phase, the items generated for the instrument were drawn from a comprehensive literature review along with a polling of experts. Then the psychometric properties were measured. Results: A Scale-Level Content Validity Index of 0.90 for the primary instrument with 36 items was obtained. The factor structure of inventory was identified by undertaking a Principal Component Analysis in a sample of 361 nurses. Three factors were extracted with a total variance account of 62.67%. Reliability was demonstrated with Cronbach’s alpha coefficient = 0.92. Consistency of instrument was established with test-retest reliability (Intra Cluster Correlation = 0.93, P<0.001). Conclusion: The major focus of this study was to develop a locally sensitive instrument to assess the facilitators and barriers to Iranian nurses’ participation in continuing education programs.
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Hanna T, Mona E. Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1161-75. [PMID: 24448633 PMCID: PMC3924497 DOI: 10.3390/ijerph110101161] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 12/05/2022]
Abstract
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.
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Affiliation(s)
- Tuvesson Hanna
- School of Health Science, Blekinge Institute of Technology, SE-37971 Karlskrona, Sweden.
| | - Eklund Mona
- School of Health Science, Blekinge Institute of Technology, SE-37971 Karlskrona, Sweden.
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