A measurement tool for assessing stress among mental health nurses

Psychometric Properties of the Korean Version of the Mental Health Professionals Stress Scale

Background: Job stress of mental health professionals can have a negative impact on them, particularly their psychological health and mortality, and may also affect organizations' and institutions' ability to provide quality mental health services to patients. Aim: This study aimed to: (1) investigate the validity and reliability of the Korean Mental Health Professionals Stress Scale (K-MHPSS), (2) develop K-MHPSS cut-off points to measure clinical depression and anxiety, and (3) examine whether specific stressors vary by area of expertise. Methodology: Data were collected via an online survey over 3 months, from August to October 2020. An online survey using a survey website was administered to volunteers who accessed the link and consented to participate. Data from 558 participants (200 clinical psychologists, 157 nurses, and 201 social workers) were included in the final analysis. Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the K-MHPSS; concurrent validity of the scale was determined by analyzing correlation; internal consistency was determined by Cronbach's alpha coefficient. In addition, ROC curve analysis and Youden's index were used to estimate optimal cut-off points for K-MHPSS; one-way ANOVA was performed to investigate the difference among the three groups. Results: The seven-factor model of the original scale did not be replicated by Korean mental health professionals. The K-MHPSS had the best fit with the six-factor model, which consists of 34 items. Concurrent validity was confirmed, and overall reliability was found to be good. The K-MHPSS cut-off points for depression and anxiety appeared to slightly different by professional groups. Furthermore, nurses and social workers showed significantly higher total scores compared to clinical psychologists, and there are significant differences in subscale scores among professionals. Conclusion: The Korean version of the MHPSS has appropriate psychometric properties and can be used to assess the occupational stress of mental health professionals. It can also serve as a reference point for screening clinical level of depression and anxiety in mental health professionals.

A Systematic Review of the Effects of Stress and Coping Strategies Used by Occupational Therapists Working in Mental Health Settings

A systematic review of the research literature published in the United Kingdom between 1966 and 2000 was carried out to determine the effectiveness of stress management interventions for occupational therapists working in mental health settings. Studies from other countries were examined as potential models of good practice. The review was limited to primary research papers that involved occupational therapists working in the mental health arenas, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data were provided.

The initial search identified 30 papers, of which 13 met the inclusion criteria. One study has been reported since the completion of the review and has been included in this article. All the papers focused on the stressors, moderators and stress outcomes. There was no paper that specifically investigated the effectiveness of stress management interventions for occupational therapists working in the mental health arena. The only literature available was aimed at the occupational therapy profession as a whole and was in the form of a number of recommendations at an organisational and an individual level. Methodological flaws, however, detracted from the rigour of many of the studies.

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure stress and about the impact of stress on a range of outcome indicators. What was found to be lacking was a translation of these results either into practice or into research that assessed the impact of interventions that attempted to moderate, minimise or eliminate some of these stressors.

Organizational Wellbeing among Workers in Mental Health Services: A Pilot Study

INTRODUCTION

Organizational wellbeing in mental health services influences the outcomes of users and their families. Workers should be motivated, have a positive morale and be able to recognize values and the deep meaning of their work. This survey aims to examine the organizational wellbeing of the services provided by the Department of Mental Health (DSM) in Lanusei (Italy) and the correlations between job satisfaction and the psychosomatic health of its workers.

MATERIALS AND METHODOLOGY

Descriptive-correlational study on a population of 43 mental health workers. Organizational wellbeing, as well as workers' job satisfaction and psychosomatic health, were measured using the "Multidimensional Organizational Health Questionnaire" (MOHQ). It is a self-report questionnaire able to examine 14 dimensions of organizational wellbeing, 14 indicators about individual discomfort, 12 indicators about individual wellbeing, 8 psychosomatic symptoms related to job distress.

RESULTS

31 workers (72%) participated in the survey. Regarding the organizational wellbeing of DSM, the general profile mean±sd was 2.66±0.28 (values from 1 to 4: 1=never, 4=often). Job satisfaction was negatively correlated with headaches and concentration difficulties (R=-.584, p=0.001), nervousness, restlessness, anxiety (R=-.571, p=0.001), sense of excessive fatigue (R=-.634, p=0.000) and sense of depression (R=-.558, p=0.001) reported by workers.

CONCLUSIONS

Data denoted an overall healthy state of the DSM. There were significant correlations between workers' job satisfaction and their psychosomatic health. The recognition and restitution about the weakness and strengths of the services could be useful to point out some organizational development perspectives.

Mental health nursing students' experience of stress: burdened by a heavy load

This paper reports research outcomes of a study into personal stress experienced by mental health student nurses undertaking a diploma programme in Ireland. It uses a phenomenological research approach. The sample was purposive and involved in-depth interviews with six students. The purpose of the study was to contribute to the knowledge of the impact of personal life stressors. Findings from this study focus on the following themes: event, meaning, effects, ability to move beyond the stress, influence on life and constraints and demands. Key points arising are that the stress experience does impact students' internal and external worlds, potentially lessening functioning and inhibiting growth and development. This paper presents student narratives that offer insights into their inner worlds, providing true accounts of the essence of stress for them. This knowledge has implications for lecturers, personal tutors, nurse educationalists and nursing curricula, highlighting need for more proactive approaches to the provision of guidance on professional support for students and staff. Insights derived from this study are relevant not only to mental health nurse education but also to academic staff delivering professional education programmes to healthcare practitioners in a variety of settings.

Stress, burnout and job satisfaction in rural psychiatric nurses: A Victorian study

OBJECTIVE

To measure the level of stress, burnout and job satisfaction in rural psychiatric nurses in Victoria, Australia.

METHOD

This present study presents the findings of a research study undertaken with rural psychiatric nurses (n = 136) in two rural mental health services in Victoria. The study designed to measure their level of stress, burnout and job satisfaction using the Maslach Burnout Inventory (MBI), the Nursing Stress Scale (NSS) and Job Satisfaction Scale (JSS).

RESULTS

The findings indicated that a low number rural psychiatric nurses suffered from 'high' level of burnout and the majority of nurses reported 'low level' of emotional exhaustion and depersonalisation scores. On the personal accomplishment subscale, only 11% recorded a 'high' score and 87% recorded 'low' score. On the Nursing Stress Scale, the 'workload' was the highest perceived stressor followed by 'inadequate preparation'.

CONCLUSIONS

Paradoxically, the majority of rural psychiatric nurses stated that they were satisfied with their job, particularly with current situation at work, aspects of support and the level of involvement in decision making.

Identifying sources and effects of carer fatigue and burnout for mental health nurses: a qualitative approach

This project aimed to: identify work-related problems to assist mental health nurses to locate the sources and effects of carer fatigue and burnout, set up a dialogue between the participants and the identified sources of stress in the workplace to address the identified problems, and make recommendations to a local Area Health Service to prevent and manage stressors in the practice of mental health nursing. In total, 20 experienced registered nurses working as mental health nurses were enlisted through a snowballing method of recruitment, and convenience sampling was used to intentionally target those research participants who were interested in identifying sources of carer fatigue and burnout in their work. Data collection was via semistructured interviews which used questions reflecting the first stage of White and Epston's (1990) method of narrative therapy, in which relative influence questioning is used to externalize the problem. The research questions related to the effect of burnout in mental health nursing across various interfaces, through the dominant story of emotional stress and fatigue. The sources of work-related problems for mental health nurses that contribute towards their experiences of carer fatigue and burnout were: employment insecurity and casualization of the work-force; issues with management and the system; difficulties with the nature of the work, inadequate resources and services, problems with doctors, aggressive and criminal consumers, undervaluing consumers and nurses, physical and emotional constraints of the work setting, and nurse-nurse relationships and horizontal violence. The effects of stress were shown in dealing with and reacting to work place stressors.

A systematic review of stress and stress management interventions for mental health nurses

BACKGROUND

Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained.

AIM

The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies.

METHOD

A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided.

RESULTS

The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies.

CONCLUSIONS

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.

Burnout and job satisfaction: a comparative study of psychiatric nurses from forensic and a mainstream mental health service

Within the nursing profession stress and burnout are considered to be widely present and problematic. These factors tend to impact negatively on job satisfaction and ultimately affect the retention of nurses. Psychiatric/mental health nursing as a specialty is considered to be a highly stressful environment; however, there is a paucity of research in this area. The current study adopted a survey design to compare forensic psychiatric nurses (n = 51) with psychiatric nurses from a mainstreamed mental health service (n = 78) in relation to burnout and job satisfaction. Forensic nurses displayed lower burnout and higher job satisfaction than their counterparts from the mainstreamed services. These findings are surprising in light of the image of forensic psychiatric nursing as dangerous and unpredictable.

The impact on work-related stress of mental health teams following team-based learning on clinical risk management

Risk management is viewed as a systematic process based on multiprofessional and multi-agency decision-making. A learning pack was developed as part of a team-based learning project aiming to encourage and develop collaborative working practice. This brought different professionals and agencies working in mental health together to learn. There is little doubt that mental health practice is a source of stress for practitioners. Apart from the stress associated with managing 'risky' situations, risk management is also a relatively new concept. This can increase stress around ability to cope, both on an individual practitioner level and in teams. This article reports the impact that the learning pack had on team members' stress, specifically work-related stress. A range of scales were used to measure change in stress and results demonstrated reduced work-related pressure in a number of areas following the learning. The implications for team learning in relation to clinical risk management are discussed in light of the findings.

Literature review of role stress/strain on nurses: an international perspective

The presence of role stress/strain among nurses has been of concern throughout the world. However, to date, no one has conducted, from an international perspective, a literature review of research on the topic. This article assesses research from 17 countries, identifies the major areas of focus in the studies, compares and contrasts the findings, summarizes the state of the science on role stress/strain on nurses and makes recommendations for future research.

The nurse retention, quality of care and patient satisfaction chain

This paper proposes an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention, healthcare quality and patient satisfaction. The paper depicts and describes a generic conceptual framework or chain derived from a review of the literature on nurse recruitment and retention, service quality and human resource management. The chain is made up of the following components: NHS and Trust conditions and environment (internal quality)--service capability--nurse satisfaction--nurse retention--quality of patient care--patient satisfaction. The value of the chain is derived from its synthesis and display of the prime constituents or drivers of nurse satisfaction, quality of patient care and satisfaction. From this holistic picture it is possible for both national and local initiatives to be integrated in a mutually reinforcing way in order to achieve improvements in nurse recruitment, retention, quality of care and patient satisfaction.

Stress in mental health nursing

Although there have been growing concerns about stress in nursing over recent years, research has primarily focused on general nurses. This paper reports on stress in mental health nursing. The data were obtained, via questionnaires, from mental health nurses at the end of their training. Four-hundred and forty-seven questionnaires were returned, an 80% response rate. Open-ended questions were asked about the nurses' experiences of stress during their time as a student, and what they anticipated would be stressful once qualified. A wide range of stresses were identified, many similar to those reported in previous studies. The open-ended nature of the questions, however, provided greater detail about the nature of stress in mental health nursing than has been reported hitherto. This detail points to broader perspectives which might be taken in future research which, in turn, may lead to a fuller understanding of nurses' experiences of stress.

Stress and burnout in community mental health nursing: a review of the literature

There is a growing body of evidence that suggests that many community mental health nurses (CMHNs) experience considerable stress and burnout. This review aimed to bring together the research evidence in this area for CMHNs working within the UK. Seventeen papers were identified in the literature, seven of which looked at stress and burnout for all members of community mental health teams (CMHTs) and the remaining 10 papers focused on CMHNs. The evidence indicates that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout as a result of increasing workloads, increasing administration and lack of resources. For CMHNs specific stressors were identified. These included increases in workload and administration, time management, inappropriate referrals, safety issues, role conflict, role ambiguity, lack of supervision, not having enough time for personal study and NHS reforms, general working conditions and lack of funding and resources. Areas for future research are described and the current study of Welsh CMHNs is announced. This review has been completed against a background of further significant changes in the health service. In the mental health field, specific new initiatives will have a significant impact on the practice of community mental health nursing. A new National Framework for Mental Health, along with a review of the Mental Health Act (1983), will undoubtedly help to shape the future practice of mental health nursing.

Individual and organizational well-being in psychiatric nursing: a cross-cultural study

Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses' well-being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho-social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho-social work environment and feelings of professional fulfillment, mental energy and work-related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well-being more favourably, Swedish psychiatric nurses reported greater individual well-being than their counterparts. Multiple regression analyses indicated that self-esteem was important for explaining mental energy and work-related exhaustion, but less so for explaining professional fulfillment, which was predicted primarily by organizational factors. When controlling for self-esteem, which was higher amongst the Swedish nurses, the differences in professional fulfillment and mental health were no longer significant. Reasons for the differences in self-esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.

Job satisfaction and stress in staff working in a specialist psychiatric unit for the elderly following relocation from a traditional psychiatric hospital setting

AIM

This study examines self-reported stress and job satisfaction of staff working in a specialist psychiatric unit for the elderly (n = 79) following relocation from a traditional psychiatric hospital setting (n = 66). The levels of reported stress were examined in relation to the two staff groups before and after the relocation, and in relation to data available for similar occupational groups.

METHODS

Stress and job satisfaction levels were surveyed using the Occupational Stress Indicator. The analysis of data included t-test for independent groups.

FINDINGS

The results suggested that that there were no significant changes in the patterns of the staff groups' experience of stress at the traditional psychiatric hospital and later at the new purpose-built unit. However, it was felt that there may have been different factors contributing to staff stress at the two time-points. The staff groups in this survey reported similar, and in some areas more positive levels of occupational stress than both community and other health authority samples. However, it was felt that, due to the limited response rate of staff at both times (63 and 59%), the results may be an underestimate of stress levels. In the absence of a measure of general health and symptomatology it was not possible to assess the impact of stress levels on the psychological well-being of staff.

CONCLUSIONS

Routine audit of staff stress would be beneficial to identify potential for staff training, and individual professional development plans. This is particularly important in view of the current difficulties both locally and nationally in the recruitment and retention of qualified staff in this speciality.

Nursing students' perceptions of their first mental health placement

The way in which the theory and practice of mental health nursing is presented to students is of particular importance, especially at a time when recruitment into the profession is falling. This study sought to examine how nursing students experience their first mental health placement. A pre-/post-test design was used with a standardized instrument (Attitude Towards Psychiatry questionnaire) to assess the influence of their mental health placements on nursing students' attitudes towards mental health nurses, mental health nursing practice and education and theoretical aspects of mental health nursing. Results suggest that the placements were effective in improving students' regard in each of these areas. Though no generalizable conclusions can be inferred from this study some interesting insights are provided by nursing students into their perceptions of current mental health nursing practice.

Predictors of a healthy workplace for Swedish and English psychiatrists

BACKGROUND

Few studies have attempted to analyse the organisational aspects of the workplace that may affect the well-being of psychiatrists and even fewer have offered insights into what a positive workplace might look like. This study provides an outline of such a workplace, with reference to individual and organisational factors. In addition, a comparison is made between two European cities to check for cultural differences.

METHOD

Three hundred and eighty psychiatrists from Stockholm and Birmingham responded to a previously tested questionnaire on their work environment.

RESULTS

Predictors of a positive workplace for psychiatrists were: high self-esteem, satisfactory support with work-related problems, lower perceived workload, positive view of leadership, low work-related exhaustion and having a sense of participation in the organisation. There were few cultural differences.

CONCLUSIONS

Measures should be taken to improve leadership skills for managers, to offer more support for work-related problems, and to allow psychiatrists to participate more in the organisation.

Stress in clinical psychologists

This paper summarises the findings of a series of studies of British clinical psychologists and discusses them in relation to the (mainly US) literature. Four main questions are addressed: (1) How stressed are clinical psychologists? (2) Which psychologists are most stressed? (3) What are the main sources of stress for clinical psychologists? and (4) What coping strategies are used by clinical psychologists? A figure summarises the main risk factors emerging from the literature which appear to be important mediators between the stressor and the psychological outcome variables. These are: (1) low job satisfaction; (2) low range of active coping strategies; (3) high use of avoidance coping strategies involving denial; (4) stressor not externalised and objectified; (5) stressor threatens other roles/relationships; (6) low experience in job; (7) no quality relationship with confidant(e)/poor quality relationship with partner; and (8) female.