Assessing occupational stress in psychiatric nurses using the full job strain model: the value of social support to nurses

Association between social support and postpartum depression

Postpartum depression is common; however, little is known about its relationship to social support and postpartum depression. This study examined the association between them among South Korean women within one year of childbirth. This study was based on the 2016 Korean Study of Women’s Health-Related Issues (K-Stori), a cross-sectional survey employing nationally-representative random sampling. Participants were 1,654 postpartum women within a year of giving birth. Chi-square test and logistic regression analysis were conducted to analyze the associations between social support (and other covariates) and postpartum depression. Among participants, 266 (16.1%) had postpartum depression. Depending on the level of social support, 6.0%, 53.9%, and 40.1% of them had low, moderate, and high social support, respectively. Women with moderate or low social support were more likely to have postpartum depression (OR = 1.78, 95% CI = 1.26–2.53; OR = 2.76, 95% CI = 1.56–4.89). This trend was observed in participants with multiparity, pregnancy loss, obese body image, and employed women. Social support was associated with a decreased likelihood of postpartum depression, indicating the importance of social support, especially for women experiencing multiparity, pregnancy loss, negative body image, as well as for employed women.

Sources of Social Support After Patient Assault as Related to Staff Well-Being

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

Ethical leadership and decision authority effects on nurses' engagement, exhaustion, and turnover intention

AIM

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

BACKGROUND

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority.

DESIGN

A descriptive, cross-sectional survey design was used across three hospital sites.

METHODS

A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis.

RESULTS

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

CONCLUSIONS

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

IMPACT

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.

A Study on the Job Retention Intention of Nurses Based on Social Support in the COVID-19 Situation

This study investigated how social support influences the job engagement and job retention intention of nurses struggling in the continuing scenes of the COVID-19 pandemic. To this end, 382 nurses were the participants, data from 377 of whom were analyzed in total, with the following results. First, it showed that nurses’ job engagement and job retention intention were high, depending on their age and work experience. Second, in terms of the factors related to COVID-19, the group with experience in nursing patients infected with COVID-19 and nurses working in COVID-19 divisions had low job retention intention. Lastly, it appeared that there were differences in job engagement and job retention intention depending on the category and type of social support. These results suggest that social support should be provided strategically to ensure nurses’ job retention.

How Do Nurses Cope with Shift Work? A Qualitative Analysis of Open-Ended Responses from a Survey of Nurses

Nurses are frequently required to engage in shift work given the 24/7 nature of modern healthcare provision. Despite the health and wellbeing costs associated with shift work, little is known about the types of coping strategies employed by nurses. It may be important for nurses to adopt strategies to cope with shift work in order to prevent burnout, maintain wellbeing, and ensure high quality care to patients. This paper explores common strategies employed by nurses to cope with shift work. A workforce survey was completed by 449 shift working nurses that were recruited from a major metropolitan health service in Melbourne, Australia. Responses to open-ended questions about coping strategies were analysed using the framework approach to thematic analysis. Four interconnected main themes emerged from the data: (i) health practices, (ii) social and leisure, (iii) cognitive coping strategies, and (iv) work-related coping strategies. Although a range of coping strategies were identified, sleep difficulties often hindered the effective use of coping strategies, potentially exacerbating poor health outcomes. Findings suggest that in addition to improving nurses' abilities to employ effective coping strategies on an individual level, workplaces also play an important role in facilitating nurses' wellbeing.

Stress in nurses: The 100 top-cited papers published in nursing journals

AIM

To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals.

BACKGROUND

The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge.

DESIGN

A retrospective bibliometric analysis.

DATA SOURCES

In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals.

REVIEW METHODS

The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated.

RESULTS

They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing.

CONCLUSION

The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.

Conceptualizing the dynamics of workplace stress: a systems-based study of nursing aides

Background

Workplace stress is a complex phenomenon that may often be dynamic and evolving over time. Traditional linear modeling does not allow representation of recursive feedback loops among the implicated factors. The objective of this study was to develop a multidimensional system dynamics model (SDM) of workplace stress among nursing aides and conduct simulations to illustrate how changes in psychosocial perceptions and workplace factors might influence workplace stress over time.

Methods

Eight key informants with prior experience in a large study of US nursing home workers participated in model building. Participants brainstormed the range of components related to workplace stress. Components were grouped together based on common themes and translated into feedback loops. The SDM was parameterized through key informant insight on the shape and magnitude of the relationship between model components. Model construction was also supported utilizing survey data collected as part of the larger study. All data was entered into the software program, Vensim. Simulations were conducted to examine how adaptations to model components would influence workplace stress.

Results

The SDM included perceptions of organizational conditions (e.g., job demands and job control), workplace social support (i.e., managerial and coworker social support), workplace safety, and demands outside of work (i.e. work-family conflict). Each component was part of a reinforcing feedback loop. Simulations exhibited that scenarios with increasing job control and decreasing job demands led to a decline in workplace stress. Within the context of the system, the effects of workplace social support, workplace safety, and work-family conflict were relatively minor.

Conclusion

SDM methodology offers a unique perspective for researchers and practitioners to view workplace stress as a dynamic process. The portrayal of multiple recursive feedback loops can guide the development of policies and programs within complex organizational contexts with attention both to interactions among causes and avoidance of adverse unintended consequences. While additional research is needed to further test the modeling approach, findings might underscore the need to direct workplace interventions towards changing organizational conditions for nursing aides.

Occupational Stress and Coping among Nurses

This paper explores nurses’ occupational stressors and coping mechanisms. In nurses occupational stress appears to vary according to individual and job characteristics, and work-family conflict. Common occupational stressors among nurses are workload, role ambiguity, interpersonal relationships, and death and dying concerns. Emotional distress, burnout and psychological morbidity could also result from occupational stress. Nurses’ common coping mechanisms include problem solving, social support and avoidance. Perceived control appears to be an important mediator of occupational stress. Coping and job satisfaction appear to be reciprocally related. Shift work is highly prevalent among nurses and a significant source of stress. The effects, moderating influences, coping mechanisms and risk factors associated with shift work are considered in detail here. Prophylactic and curative measures are important for nurses at both personal as well as organisational levels.

Coping with Workplace Violence in Healthcare Settings: Social Support and Strategies

A cross-sectional survey of healthcare professionals from 19 hospitals in six cities of Heilongjiang Province, China was conducted. This study had two objectives: (1) to examine the factors influencing healthcare workers' opinions of strategies to prevent workplace violence, using social support theory, and (2) to encourage healthcare organisations and the larger society to offer greater support to healthcare workers. The respondents exposed to workplace violence expected to receive organisational and social support. Those exposed to psychological violence had a strong opinion of the need for target training to strengthen their competence in responding to violence (OR = 1.319, 95% CI: 1.034-1.658) and enacting workplace violence legislation (OR = 1.968, 95% CI: 1.523-2.543).Those exposed to physical violence thought it might be useful to reinforce staff with back-up support (OR = 3.101, 95% CI: 1.085-8.860). Those exposed to both types of violence and those with high anxiety levels need greater support at both the organisational and societal levels.

Relationships of job demand, job control, and social support on intention to leave and depressive symptoms in Japanese nurses

This study aims to elucidate the relationships among the factors of the demand-control-support model (DCS) on the intention to leave a hospital job and depressive symptoms. Participants included 1,063 nurses. Job demand, job control, and support from supervisors were found to be significantly related to both the intention to leave and depressive symptoms. Based on the odds ratios per 1 SD change in the DCS factors, low support from supervisors was found to be most related to the intention to leave, and low job control was found to be most related to depressive symptoms. In models that did not include "job demand" as an independent variable, 60-h working weeks were found to have a significantly higher odds ratio for depressive symptoms. Support from supervisors is more important in preventing intention to leave and depressive symptoms among nurses than is support from co-workers. Improving job control and avoiding long working hours may be important to prevent depressive symptoms.

Job strain and psychological distress among employed pregnant Thai women: role of social support and coping strategies

Most Thai women continue to work throughout their pregnancy; however, little is known about job strain and its relation to psychological distress. This study aimed to examine: (1) the direct effects of job strain, perceived workplace support, perceived family support, and coping strategies on psychological distress and (2) the moderating effect of perceived workplace support, perceived family support, and coping strategies on the relationship between job strain and psychological distress. Lazarus and Folkman's transactional model of stress and coping guided this cross-sectional study. Full-time employed pregnant women (N = 300) were recruited from three antenatal clinics in Thailand. Thai versions of the following instruments were used: the State-Anxiety Inventory and Center for Epidemiological Studies-Depression Scale (psychological distress), the Job Content Questionnaire (job strain and perceived workplace support), the Medical Outcome Study Social Support Survey (perceived family support), and the Ways of Coping Checklist-Revised (coping strategies). Job strain with other predictors explained 54% of the variance in psychological distress. In the separate hierarchical multiple linear regression models, two types of coping strategies, seeking social support and wishful thinking, moderated the effects of job strain on psychological distress. Perceived family support had a direct effect in reducing psychological distress. Job strain is a significant contributor to psychological distress. The average levels of seeking social support and wishful thinking were most beneficial in moderating the negative impact of job strain on psychological distress. Since perceived workplace and family support did not have moderating effects, stress management programs for decreasing the levels of job strain should be developed.

Relational regulation theory and the role of social support and organisational fairness for nurses in a general acute context

AIMS AND OBJECTIVES

To present a novel approach to nurse stress by exploring the demand-control-support model with organisational justice through the lens of relational regulation theory.

BACKGROUND

Nursing is often stressful due to high demands and dissatisfaction with pay, which impacts the mental well-being and productivity of nurses.

DESIGN

A cross-sectional design.

METHODS

A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-sized general acute hospital in Australia. A total of 190 nurses and midwives returned completed questionnaires for the analyses.

RESULTS

The multiple regression analyses demonstrated that the model applies to the prototypical context of a general acute hospital and that job control, supervisor support and outside work support improve the job satisfaction and mental health of nurses.

CONCLUSIONS

Most importantly, supervisor support was found to buffer the impact of excessive work demands. Fairness of procedures, distribution of resources and the quality and consistency of information are also beneficial. Relational regulation theory is applied to these findings as a novel way to conceptualise the mechanisms of support and fairness in nursing.

RELEVANCE TO CLINICAL PRACTICE

The importance of nurses' well-being and job satisfaction is a priority for improving clinical outcomes. Practically, this means nurse managers should be encouraging nurses in the pursuit of diverse relational activities both at work and outside work.

Job satisfaction and intentions to leave of new nurses

Turnover of newly graduated nurses is of significant concern. There are continuing reports that new graduates struggle during the transition to the work setting. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job satisfaction and intention to leave of new nurses utilising Karasek's Job Demands-Control-Support model. A cross-sectional mailed survey was used to gather data. The sample comprised 232 new nurses working in acute care in Canada. Job demands, social support from both supervisors and coworkers and self-efficacy were significantly related to job dissatisfaction, while demands and support from coworkers were related to intention to leave the job. Identifying factors that contribute to the job satisfaction and intentions to leave of new nurses is a first step in developing interventions to assist nurses who are just beginning their careers.

Depressive symptoms among Chinese nurses: prevalence and the associated factors

AIM

  This article is a report of exploration of depressive symptoms and the associated factors among Chinese nurses working at public city hospitals.

BACKGROUND

  Hospital nurses are known to work in psychologically and physically demanding work environment, which may lead to depressive symptoms. However, little research has been done to address this problem in Chinese nurses.

METHODS

  A cross-sectional survey was carried out in seven randomly selected city hospitals of Liaoning Province, northeast of China in 2009. Depressive symptoms of the nurses were measured with the Chinese version of the Center for Epidemiologic Studies Depression Scale. Job Content Questionnaire and the effort-reward imbalance, demographic features, life style and work conditions were measured as the related factors.

RESULTS

  A total of 1592 nurses participated in the study and the effective response rate was 79·5%. The prevalence of depressive symptoms among the nurses was 61·7% (n = 886), of whom 74·9% (n = 664) had mild depressive symptoms. Multivariate logistic regression analysis showed that lower job rank, higher over commitment, alcohol consumption, worse nurse-patient relationship and higher education background were positively associated with depressive symptoms, whereas supervisor support, taking regular meals, doing physical exercises, higher skill discretion and higher job satisfaction were negatively associated with depressive symptoms.

CONCLUSION

  More than half of the Chinese nurses had depressive symptoms. As depressive symptoms may adversely affect quality of life and quality of care, consultation for the nurses with healthy life styles, work stress coping techniques and advice to administrator to improve social aspects of the work environment might be helpful to reduce the depressive symptoms in nurses.

Being different: a phenomenological exploration of a group of veteran psychiatric nurses

Concern regarding the low numbers of graduate nurses expressing interest in entering the psychiatric field leads to the question: who would be a psychiatric nurse? In this interpretative, phenomenological study, the lived experiences of seven veteran psychiatric nurses were examined in order to gain understanding of the reasons why they had remained in the field of psychiatric nursing. Each of these participants had more than 10 years' clinical practice in psychiatric nursing and shared a wide range of thoughts, memories, and experiences. The major emergent theme, 'being different', revealed what it is like for the participants being psychiatric nurses. These participants felt and saw themselves as different in many ways from other nurses and from society in general. Related to and an aspect of that difference was the high level of satisfaction they achieved from their role and the striving to achieve harmony.

The relationship between lifestyle, working environment, socio-demographic factors and expulsion from the labour market due to disability pension among nurses

BACKGROUND

Denmark is facing a shortage of nurses and this trend is anticipated to worsen within the next decades. The major reason for this shortage is that only very few nurses remain employed until the general retirement age. Every year several nurses are expelled from the labour market prematurely which causes a problem not only for the disabled nurses but also because it can affect the morale and productivity among the remaining personnel while new staff members are hired and trained.

AIM

The aim of the study was to analyse the relationship between lifestyle, working environment, socio-demographic factors and disability pension (DP) among nurses.

METHODS

The study was based on 12,028 nurses above the age of 44 who in 1993 completed a questionnaire. The survey information was combined with longitudinal data from a register compiled by Statistics Denmark. The follow-up period was from 1993 to 2002.

RESULTS

Nurses with relatively low gross incomes were more likely to become disability pensioners compared to nurses with high incomes (hazard ratio, HR 1.33 and HR 2.17). Also, nurses who were singles had a higher probability of entering DP (HR 1.63). Nurses who worked fixed evening or night shifts had higher risks of DP than nurses who worked daytime exclusively (HR 1.51 and HR 1.45). Smoking, obesity and having a sedentary lifestyle were also risk indicators for DP (HR 1.42, HR 1.63 and HR 1.50). Furthermore, low influence and high physical demands at work increased the probability of entering DP (HR 1.39 and HR 1.22).

CONCLUSION

DP among nurses is influenced by a number of factors. Nurses who have poor working environments and/or unhealthy lifestyles have higher risks of becoming disability pensioners. Also, nurses who are singles and/or have low gross incomes have higher probability of entering DP.

Patient safety and job-related stress: a focus group study

This study focused on work-related stress among nurses working with critically ill patients. The aim of the study was to examine the effects of work-related stress with regard to patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two regional hospitals were chosen. Inclusion criteria for the focus group panels included the following: nurses with advanced training in anesthesiology, intensive care, or operating-room nursing. Twenty-three nurses were chosen and they were divided into four groups. This study shows that a demanding work environment together with minimal control and social support from colleagues results in increased stress that can often have an effect on patient safety.

Striving for balance: A grounded theory study of health experiences of nurses with musculoskeletal problems

BACKGROUND

Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration.

OBJECTIVES

The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms.

DESIGN

A qualitative grounded theory approach guided the study in data collection and analysis.

SETTINGS

Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals.

PARTICIPANTS

Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages.

METHODS

A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons.

RESULTS

The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness.

CONCLUSION

This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

Exploring the relationship between perceived emotional intelligence, coping, social support and mental health in nursing students

Studies conducted with nurses or nursing students have shown that emotional intelligence is a skill that minimizes the negative stress consequences. The present work examines the role of perceived emotional intelligence (PEI) measured by the Trait Meta-Mood Scale, in the use of stress-coping strategies, in the quantity and quality of social support and in the mental health of nursing students. The results indicated positive correlations between clarity and social support, social support and repair, and social support and mental health. Hierarchy regression analysis pointed out that clarity and emotional repair are predictors of social support, and emotional repair is the main predictor of mental health. These results show the importance of PEI in stress coping within the nursing framework.

The relationship between supervisor support and registered nurse outcomes in nursing care units

Workplace social support is a major characteristic related to the Job Demand-Control model of job stress. Organizational and managerial support have an effect on nurse satisfaction and burnout. The relationships between perceived supervisor support and measures of nurse occupation-related outcomes were investigated in 3 nursing units within an academic medical center. Nurses with greater levels of perceived supervisor support experienced more positive job outcomes and less negative outcomes, including less occupational stress, than nurses with less perceived supervisor support. Implications for refocusing the role of the nurse supervisor and its effect on multiple nursing occupation-related outcomes are discussed.

Psychosocial work stress is associated with poor self-rated health in Danish nurses: a test of the effort-reward imbalance model

Nursing staff are exposed to stressful work load which in turn is associated with poor physical and psychological health, sickness absence and job exit. The effort-reward imbalance (ERI) model is a validated approach to measure chronic psychosocial work stress by identifying nonreciprocity between occupational efforts spent and rewards received, and has been found to predict poor health. The aim of this cross-sectional study (n = 367 nurses and nurses aides) was first to test the psychometric properties of the Danish questionnaire measuring ERI, and secondly to analyse whether psychosocial work stress is associated with six indicators of poor self-rated health. Results derived from confirmatory factor analysis indicate satisfying psychometric properties. Elevated risks of poor self-rated health (odds ratios varying from 1.92 to 4.76) are observed in nursing staff characterized by high effort in combination with low reward. Effects are enhanced in those respondents who additionally exhibit a high level of work-related overcommitment. In conclusion, despite methodological limitations, this study contributes to the validation of the ERI questionnaire in Danish language. Furthermore, by documenting associations with poor self-rated health, it supports efforts of theory-guided prevention of work stress in health care professions.

The prevalence of nursing staff stress on adult acute psychiatric in-patient wards. A systematic review

BACKGROUND

Concerns about recent changes in acute in-patient mental health care environments have led to fears about staff stress and poor morale in acute in-patient mental health care staff.

AIM

To review the prevalence of low staff morale, stress, burnout, job satisfaction and psychological well-being amongst staff working in in-patient psychiatric wards.

METHOD

Systematic review.

RESULTS

Of 34 mental health studies identified, 13 were specific to acute in-patient settings, and 21 were specific to other non-specified ward-based samples. Most studies did not find very high levels of staff burnout and poor morale but were mostly small, of poor quality and provided incomplete or non-standardised prevalence data.

CONCLUSIONS

The prevalence of indicators of low morale on acute in-patient mental health wards has been poorly researched and remains unclear. Multi-site, prospective epidemiological studies using validated measures of stress together with personal and organizational variables influencing staff stress in acute in-patient wards are required.

Beyond usability: designing effective technology implementation systems to promote patient safety

Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.

Beyond usability: designing effective technology implementation systems to promote patient safety

Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.

Nurse managers' professional networks, psychosocial resources and self-rated health

BACKGROUND

Nurse managers act under constant pressure to develop strategies in response to professional challenges within a changing and restructured health care system. When such environmental stress is present, they need access to sufficient psychosocial recourse.

AIM

The study aimed to investigate whether nurse managers' professional networks, psychosocial work conditions, job support, social network and support were associated with self-rated health, sick-leave and salary.

METHODS

From a total of 268 Swedish nurse managers, active in management positions, 205 (77%) agreed to participate in the study by answering a self-report questionnaire. Cronbach's alpha was used to calculate internal consistency. Odds ratios were used to estimate the bivariate association between self-rated health and psychosocial resources.

RESULTS

Nurse managers exposed to high job demands had significantly increased odds for low self-rated health. It was also found that low level of support from professional network, job support, social network and social support outside work displayed increased odds for low self-rated health, independently of age, gender and education. There were additive (but no synergistic) effects found for job demand in combination with professional networks, job support and emotional support and in relation to self-rated health.

CONCLUSION

The study showed that nurse managers exposed to high job demands had elevated odds for low self-rated health, regardless of level of psychosocial resources within or outside work. Two-thirds of the nurse managers who were affiliated to professional networks did not consider this a supporting factor in their management work. Those with low job support had increased odds for sick-leave compared with those with high support. No significant associations were found between psychosocial characteristics and salary.

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.

Staff satisfaction and its components in residential aged care

OBJECTIVE

The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care.

DESIGN

A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components.

SETTING

Seventy residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

The sample includes 610 nursing home and 373 hostel care staff.

RESULTS

The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction.

CONCLUSION

The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

The relationship between emotions and stress among mental health nurses

This paper presents findings from an exploratory correlational study that examined the relationships between Emotional Competency, Trait Affectivity, Stress and Experienced Emotions among 43 mental health nurses in Australian regional hospitals. A significant relationship was found between Emotional Competency and Personal Self-doubt in male nurses only; however, no association was found between Emotional Competency and Experienced Emotions. Trait Affectivity was found to be associated with Experienced Emotions but not Stress. Gender differences were found in Trait Affectivity and Experienced Emotions. The results of the study have implications for the retention of mental health nurses in their profession.

Occupational stress in nursing: a review of the literature

The management and reduction of occupational stress are recognized as key factors in promoting employee well-being. Nursing is one of the many disciplines contributing to a huge body of research into the causes and effect of the ill-defined phenomenon of occupational stress. This literature review considers the ontological contribution of a number of disciplines to a growing body of knowledge on the subject of stress. The paper examines the complex issue of stress management, highlighting the impact of organizational culture and transformational leadership style on staff satisfaction levels.

Psychiatric nurses' lived experiences of working with inpatient care on a general team psychiatric ward

To reveal the meaning of being a nurse working with inpatient care on a team psychiatric ward in Sweden, 22 psychiatric nurses were interviewed and the transcribed texts were analysed by means of latent content analysis. Three themes emerged from the analysis: developing a working relationship with the patient in everyday caregiving; encountering and handling the unforseeable in daily living; and struggling with professional independence and dependency. Developing a working relationship with the patient in everyday caregiving meant that the nurse-patient relationship was the foundation of the caregiving and included being with, as well as doing for, and with, the patient. Four different approaches in daily caregiving were revealed: networking, teaching, containing and protecting. The nurses' approaches in the nurse-patient relationship alternated between being an 'expert' and a 'collaborator'. Encountering and handling unforeseeable situations meant that the nurses were exposed to and had to be prepared for unpredictable situations where they were on their own, handling sometimes strong emotional reactions and relying on their own ability to act. Struggling with professional independence and dependency meant that the nurses seemed to lack professional confidence, although they had many responsibilities, but also less authority to decide about overall care planning. Contextual aspects such as organizational hindrance, unsatisfactory work-environment and co-operation difficulties were illuminated. The result indicates the need for a stable and predictable organizational structure if nurses are to manage the demanding nurse-patient relationships that everyday caregiving requires. A question highlighted by this study is whether multidisciplinary team organization has been effectively developed in Sweden, as uncertainty about the roles and responsibilities of nurses was apparent.