Absence of response: a study of nurses' experience of stress in the workplace

The effectiveness of Balint group work on the quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses: a randomized controlled trial

Background

Balint group training has gained popularity in medical practices as an intervention designed to enhance the quality of life, well-being, and communication skills of healthcare practitioners. Psychiatric nurses, in particular, encounter distinct challenges and stressors inherent in their profession, necessitating the development and implementation of effective interventions to assist them in coping with the difficulties they experience. In this vein, the current study aimed to investigate the effectiveness of Balint group training on quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses.

Methods

Thirty psychiatric nurses from Razi Hospital in Tehran were recruited via the purposeful sampling method in 2022 and were randomly assigned to either the Balint group, consisting of eight weekly one-hour training sessions, or a control group. Participants completed the Walton Quality of Work Life Questionnaire, Connor-Davidson Resilience Scale, and Communication Skills Scale before and after the intervention. The data were analyzed using the Analysis of Covariance (ANCOVA).

Results

The study found no significant differences between the Balint group and the control group in terms of quality of work life, resilience, and nurse-patient communication skills.

Conclusion

Findings suggest that Balint group training was not an effective intervention for improving the well-being and communication skills of psychiatric nurses. However, the study highlights the need for further investigation into the potential factors that may explain the lack of significant gains and offers insights for future research in this area.

Effects of workload and job stress on the shift work disorders among nurses: PLS SEM modeling

Nurses, as the largest forces in the health system, are always challenged with various work responsibilities such as long working hours, lack of manpower and death of patients. This study aimed at providing a model of the relationship between workload and physical and mental health, sleep disorders, and individual and family problems by the mediation role of job stress. The present study is a cross-sectional study that was conducted on 300 nurses in a specialty and sub-specialty hospital in Tehran. For this reason, various questionnaires including demographic, survey of shift workers (SOS) and job stress questionnaires were used to collect the desired data. The proposed model was presented using structural equation modeling method based on Smart-PLS and SPSS-20 software. The results show that workload has an effect on job stress (β=0.747), mental health (β=-0.291), Physical health (β=-0.253), sleep quality (β=-0.234) and personal and family problems (β=-0.206). Also the results of this study show that job stress has an effect on mental health (β=-0.295), Physical health (β=-0.349), sleep quality (β=-0.295) and Personal and family problems (β=-0.441). In conclusion, results showed that the data fitted well with the model and that workload is associated with physical and mental problems, sleep disorders and individual and family problems both directly and indirectly through job stress mediation.

The Existential Breastfeeding Difficulty Scale’s influences on the caring dialogue—Child healthcare nurses’ lived experiences

Breastfeeding is experienced as an existential journey, and breastfeeding difficulties put mothers in existentially vulnerable situations. For care to be caring, it must be based on the mother's breastfeeding story. Previous research show that healthcare professionals struggle to perform individualised breastfeeding care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed to support an existential focus in caring dialogues and was introduced in child healthcare in Sweden.

The aim of this study is to describe child healthcare nurses’ lived experience of how the Existential Breastfeeding Difficulty Scale (ExBreastS) influences the caring dialogue.

Seventeen child healthcare nurses with experience in using ExBreastS as a basis for caring dialogues with breastfeeding mothers were interviewed, in groups, pairs or individually. The interviews were analysed using a thematic analysis based on descriptive phenomenology.

The results show that the caring dialogue becomes re‐evaluated when using ExBreastS because existential aspects of breastfeeding is acknowledged. ExBreastS also visualises new perspectives of the mother's breastfeeding experiences. However, the use of ExBreastS also risks overshadowing the caring dialogue when the nurses focus too much on the instrument.

The use of ExBreastS supports caring dialogues—and caring care—by highlighting the existential aspects of breastfeeding/breastfeeding difficulties and the uniqueness of every mothers’ breastfeeding experience. However, the instrument sometimes evokes a vulnerability in the nurses that calls for support from the care organisation.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study

BACKGROUND

The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed.

MATERIALS AND METHODS

The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software.

RESULTS

A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals.

CONCLUSION

Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

Occupational Stress Among Nurses: A Factorial Study with Special Reference to Indore City

Nurses are a stressed group and this may affect their health and work performance. Occurrence of occupational stress among nurses is becoming common and this takes a toll on their health both in terms of physical and mental health. There is minimal research on reducing occupational stress. This study aimed to determine factors of occupation stress within nurses. The present study has been undertaken on 68 employees of hospitals to understand the factors affecting occupational stress. This article reports the major factors that are constituents for occupational stress among nurses of Indore region.

Satisfaction With Work-Family Balance Mediates the Relationship Between Workplace Social Support and Depression Among Hospice Nurses

PURPOSE

The purpose of this study was to investigate the relationship between social support (from personal and workplace sources) and psychological distress (depression, anxiety, and stress symptoms), as well as to examine the mediating role of satisfaction with work-family balance among hospice nurses.

DESIGN AND METHOD

A cross-sectional study design was utilized with a sample of 90 hospice nurses from the southern United States. Participants completed online surveys, including (a) the Depression, Anxiety, and Stress Scale (DASS-21), (b) loosely adapted items from the Affectivity, Burnout, and Absenteeism Scales, and (c) Satisfaction with Work-Family Balance Scale.

FINDINGS

Workplace social support, not personal social support, was associated with lower psychological distress, and satisfaction with work-family balance mediated the relationship between workplace social support and depression symptoms, a component of psychological distress.

CONCLUSIONS

Hospice nurses' social support in the workplace and their satisfaction with the balance between their work and family lives play a role in supporting their mental health.

CLINICAL RELEVANCE

Hospice nurses may benefit from programs fostering the creation of workplace-based interpersonal relationships.

Towards resilience and wellbeing in nurses

Nursing is a physically and emotionally demanding profession. High role expectations and difficult working conditions place some nurses at risk of burnout and stress-related illness. In spite of the challenges in the current healthcare system, nurses continue to deliver high-quality patient care, retain resilience and progress professionally in the face of adversity. This article provides an overview, with discussion of the evidence in the literature, of some of the suggested methods to improve resilience and enhance staff wellbeing in the nursing profession at an individual and organisational level.

The impact of occupational stress on nurses' caring behaviors and their health related quality of life

Background

Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.

Methods

A correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.

Results

Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.

Conclusion

Occupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

Do nurses feel stressed? A perspective from primary health care

This study describes nurses' experiences of stress in primary healthcare settings, and examines correlations between stress and personal factors. There were 187 nurses from 18 public primary care centers participating, drawn from one county of Lithuania. The Expanded Nursing Stress Scale was used to evaluate the study data. The study indicates that in primary healthcare centers, nurses working with adult patients experienced less stress than those working with younger patients. The most frequently reported stressors were those related to death and dying, and conflicts with physicians and patients and their families. In particular, older nurses more frequently experienced stress related to death and dying. The intensity of nurses' stress in conflict situations with physicians was related to age, however, the depth of work experience in the healthcare setting was more influential. Findings indicate that more detailed research is needed regarding stress experiences in primary health care, and especially the related impact of the social contexts involved in the setting.

Health care managers learning by listening to subordinates’ dialogue training

Purpose

– Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates’ dialogue training.

Design/methodology/approach

– A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used.

Findings

– Managers’ experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers – such as acting democratically and pedagogically – and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors.

Research limitations/implications

– Only eight managers participated in the intervention, but data afforded a basis for further research.

Practical implications

– Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work.

Originality/value

– Studies focusing on health care managers’ communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

The ethical landscape of professional care in everyday practice as perceived by staff: A qualitative content analysis of ethical diaries written by staff in child and adolescent psychiatric in-patient care

BACKGROUND

Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept.

METHODS

The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries.

RESULTS

In the analysis three themes emerged; 1) good care 2) loyalty and 3) powerlessness. The theme 'good care' contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme 'loyalty' contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme 'powerlessness' contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and violations in the workplace.

CONCLUSIONS

The ethical considerations described by child and adolescent psychiatric care staff are multifaceted and remarkably often concern problems of loyalty and organization. These problems frequently had a considerable influence on the care provided. It seems that staff members lack a language of ethics and require both an ethical education and a forum for discussion of ethical issues.

Role stress among first-line nurse managers and registered nurses - a comparative study

BACKGROUND

Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs).

AIM

The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support).

METHODS

Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire.

RESULTS

Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support.

CONCLUSION

Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work.

IMPLICATION FOR NURSING MANAGEMENT

The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Tactile massage and hypnosis as a health promotion for nurses in emergency care--a qualitative study

BACKGROUND

This study explores nursing personnel's experiences and perceptions of receiving tactile massage and hypnosis during a personnel health promotion project. Nursing in a short term emergency ward environment can be emotionally and physically exhausting due to the stressful work environment and the high dependency patient care. A health promotion project integrating tactile massage and hypnosis with conventional physical activities was therefore introduced for nursing personnel working in this setting at a large university hospital in Sweden.

METHODS

Four semi-structured focus group discussions were conducted with volunteer nursing personnel participants after the health promotion project had been completed. There were 16 participants in the focus groups and there were 57 in the health promotion intervention. The discussions were transcribed verbatim and analysed with qualitative content analysis.

RESULTS

The findings indicated that tactile massage and hypnosis may contribute to reduced levels of stress and pain and increase work ability for some nursing personnel. The sense of well-being obtained in relation to health promotion intervention with tactile massage and hypnosis seemed to have positive implications for both work and leisure. Self-awareness, contentment and self-control may be contributing factors related to engaging in tactile massage and hypnosis that might help nursing personnel understand their patients and colleagues and helped them deal with difficult situations that occurred during their working hours.

CONCLUSION

The findings indicate that the integration of tactile massage and hypnosis in personnel health promotion may be valuable stress management options in addition to conventional physical activities.

Role stress amongst nurses at the workplace: concept analysis

AIM

The present study explicates the concept of role stress amongst nurses through an analysis adopted from Walker and Avant; Strategies for Theory Construction in Nursing, 4th edn, Prentice Hall, New Jersey, NY.

BACKGROUND

Role stress has become a significant problem amongst nurses and has created much distress leading to burnout among many in the nursing profession. It is significant to analyse the concept of role stress and its relative attributes and consequences, in order to recognize the necessary antecedents needed to create better conditions for nurses at the workplace.

EVALUATION

A modified method developed by Walker and Avant was used for this concept analysis.

KEY ISSUES

A model representing the concept of role stress was developed through careful consideration of the attributes, consequences, antecedents and empirical referents of role stress.

CONCLUSION

The concept analysis of role stress among nurses at the workplace recognized the vulnerability of the nursing discipline towards burnout and distress in general.

IMPLICATIONS FOR NURSING MANAGEMENT

It is critical to be aware of the current state of health care and note the increased workload created for nurses. Nurses are at a greater vulnerability for role stress, making it imperative for health care organizations to critically evaluate and establish preventative measures for the concept of role stress.

A Cross-Cultural Comparison of Nurses' Ethical Concerns

The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.

Nurses' Workplace Distress and Ethical Dilemmas in Tanzanian Health Care

The aim of this study was to describe Tanzanian nurses' meaning of and experiences with ethical dilemmas and workplace distress in different care settings. An open question guide was used and the study focused on the answers that 29 registered nurses supplied. The theme, `Tanzanian registered nurses' invisible and visible expressions about existential conditions in care', emerged from several subthemes as: suffering from (1) workplace distress; (2) ethical dilemmas; (3) trying to maintaining good quality nursing care; (4) lack of respect, appreciation and influence; and (5) a heavy workload that did not prevent registered nurses from struggling for better care for their patients. The analysis shows that, on a daily basis, nurses find themselves working on the edge of life and death, while they have few opportunities for doing anything about this situation. Nurses need professional guidance to gain insight and be able to reflect on their situations, so that they do not become overloaded with ethical dilemmas and workplace distress.

The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: comparison between summer and winter

AIMS AND OBJECTIVES

This research aimed to evaluate the use of aromatherapy massage and music as an intervention to cope with the occupational stress and anxiety that emergency department staff experience. The study also aimed to compare any differences in results between a summer and winter 12-week massage plan.

BACKGROUND

Emergency nurses are subjected to significant stressors during their work and it is known that workloads and patient demands influence the role stress has on nurses. The perception that winter months are busier for emergency departments has long been held and there is some evidence that people with cardiac and respiratory dysfunction do present more frequently in the winter months. Massage has been found to decrease staff anxiety.

DESIGN

The study used a one-group pre-test, post-test quasi-experimental design with random assignment.

METHOD

Staff occupational stress was assessed pre- and post- 12 weeks of aromatherapy massage with music and anxiety was measured pre and post each massage session. Sick leave was also measured. Comparisons of summer and winter data were undertaken.

RESULTS

A total of 365 massages were given over two 12-week periods, one during summer and the other during winter. Analysis identified that aromatherapy massage with music significantly reduced anxiety for both seasonal periods. Premassage anxiety was significantly higher in winter than summer. No differences in sick leave and workload were found. There was no difference in the occupational stress levels of nurses following the two 12-week periods of massage.

CONCLUSION

Emergency nurses were significantly more anxious in winter than summer but this cannot be attributed to increased sick leave or workloads. Aromatherapy massage with music significantly reduced emergency nurses' anxiety.

RELEVANCE TO CLINICAL PRACTICE

High levels of anxiety and stress can be detrimental to the physical and emotional health of emergency nurses and the provision of a support mechanism such as on-site massage as an effective strategy should be considered.

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.

Validation of Oppressed Group Behaviors in Nursing

The possibility that nurses exhibit oppressed group behaviors was first broached by Roberts [Roberts, S. J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursing Science, 21-30] when Freire's model [Freire, P. (1970). Pedagogy of the oppressed. New York: Herder and Herder] was applied to nursing. Since then, scholarly discussion has focused on aspects of oppression in nursing, but little research toward validation of Freire's model has occurred. An extensive literature search in CINAHL was completed seeking exploration and validation of the oppressed group behavior model and its dimensions. The Educational Testing Services, PsychInfo, Health and Psychosocial Instruments, and Sociological Abstracts databases were searched for measurement tools created within the last 10 years. This literature review identified that a model of oppressed group behavior has not been developed and validated, and that oppressed group behaviors have been studied independent of each other; however, oppressed group behaviors may have implications for the current nursing shortage.

Nurses' Motivators to Work Part-Time

There has been a trend of growth in part-time employment within the Australian nursing workforce and currently half of the profession work part-time. While the literature across disciplines has postulated reasons behind preferences for part-time employment, little is known about nurses' motivators to work part-time. In an era of nursing shortages that form considerable barriers to meeting healthcare service demands, a clear understanding of these motivators is critical for the effective planning and management of the nursing workforce. A grounded theory study that explored the phenomenon of part-time nursing found that nurses' motivators to work part-time were complex and identifiable with nursing, establishing that nurses' working time decisions are made in contexts that may be unique to the profession. This paper provides an exhaustive description and explanation of one cohort of part-time nurses that accounts for variations between nurses and provides an understanding of the complexity of factors that contribute to nurses' decisions to work part-time.

Workplace health promotion: the role and responsibility of health care managers

The World Health Organization's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Workplace movement emerged. Here, an extensive review of the available workplace-related health literature provides the basis for critical discussion and recommendations for health care managers. The findings suggest that health care managers, who practice in all health service settings, should be aiming to initiate and promote radical health promotion reform as set out in the WHO settings-based movement. Developing and implementing sustainable health promotion-orientated and organization-wide healthy workplace policy initiatives represent the most effective way for health care managers to directly benefit from the desirable outcomes that come from creating and maintaining a healthy workforce.