The prevalence of job stress among nurses in Iran: A meta-analysis study

Evaluation of occupational stress and job performance in Iranian nurses: the mediating effect of moral and emotional intelligence

BACKGROUND

Nurses' Job performance could be affected by occupational stress. Previous studies reported contradictory results in this regard. Factors such as moral and emotional intelligence could impact occupational stress. However, the extent of any mediating effect is unclear. Thus, this study aimed to determine the effect of occupational stress on nurses' Job performance and the mediating impact of moral and emotional intelligence.

METHODS

This cross-sectional study was conducted in Urmia teaching hospitals (Imam Khomeini, Motahari, Taleghani, Kosar, and Seyed al-Shohada Hospitals). Six hundred twenty-one nurses were selected using quota sampling from February 2022 to April 2022. Data were collected using demographic questionnaires, the Nursing Stress Scale, Paterson's Job Performance Questionnaire, Siberia Schering's Emotional Intelligence Standard Questionnaire, and Lennik and Keil's Moral Intelligence Questionnaire. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2.

RESULTS

Occupational stress had a positive, direct, and minor effect on nurses' job performance (β = 0.088, t-value = 2.245, p < 0.01). Occupational stress had a positive and direct impact on moral intelligence (β = 0.161, t-value = 2.945, p < 0.01) and a negative and direct effect on emotional intelligence (β = -0.351, t-value = 7.484, p < 0.01). Occupational stress negatively and indirectly affected job performance through moral intelligence (β =-0.560, t-value = 14.773, p < 0.01). Occupational stress also positively and indirectly impacted job performance through emotional intelligence (β = 0.098, t-value = 2.177, p < 0.01).

CONCLUSIONS

Occupational stress slightly affects nurses' job performance, and emotional and moral intelligence mediates the impact of occupational stress and improves nurses' job performance. Low occupational stress improves nurses' job performance, but too much occupational stress could harm nurses' job performance. Healthcare administrators should work to help reduce nurses' occupational stress and improve their job performance by adopting practical strategies to help nurses manage and control their stress. Holding stress reduction classes, eliminating the nursing shortage, reducing working hours, reducing workload, and providing financial and spiritual support to nurses would be recommended. It is also recommended to provide theoretical and practical emotional and moral intelligence-oriented courses for nursing students and hold training workshops for nurses to improve their emotional and moral intelligence.

The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis

OBJECTIVES

The mental health impacts of the COVID-19 pandemic continue to be documented worldwide with systematic reviews playing a pivotal role. Here we present updated findings from our systematic review and meta-analysis on the mental health impacts among hospital healthcare workers during COVID-19.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, Embase and Web Of Science Core Collection between 1st January 2000 to 17th February 2022 for studies using validated methods and reporting on the prevalence of diagnosed or probable mental health disorders in hospital healthcare workers during the COVID-19 pandemic. A meta-analysis of proportions and odds ratio was performed using a random effects model. Heterogeneity was investigated using test of subgroup differences and 95 % prediction intervals.

RESULTS

The meta-analysis included 401 studies, representing 458,754 participants across 58 countries. Pooled prevalence of depression was 28.5 % (95 % CI: 26.3-30.7), anxiety was 28.7 % (95 % CI: 26.5-31.0), PTSD was 25.5 % (95 % CI: 22.5-28.5), alcohol and substance use disorder was 25.3 % (95 % CI: 13.3-39.6) and insomnia was 24.4 % (95 % CI: 19.4-29.9). Prevalence rates were stratified by physicians, nurses, allied health, support staff and healthcare students, which varied considerably. There were significantly higher odds of probable mental health disorders in women, those working in high-risk units and those providing direct care.

LIMITATIONS

Majority of studies used self-report measures which reflected probable mental health disorders rather than actual diagnosis.

CONCLUSIONS

These updated findings have enhanced our understanding of at-risk groups working in hospitals. Targeted support and research towards these differences in mental health risks are recommended to mitigate any long-term consequences.

Perceived job demands: a qualitative study of workplace stress in the Iranian healthcare workers (HCWs)

OBJECTIVES

Work-related stress is a common risk factor among healthcare workers (HCWs). In Iran, the healthcare system has undergone extensive changes to develop services. Organisational change has led to the creation of new working conditions for HCWs. The purpose of this study is to identify job demands that health workers perceive as stressors.

DESIGN

As a qualitative study, semistructured interviews, a focus group, and related data were analysed both inductively and deductively with reference to the job demand component based on the job demands-resources model and MAXQDA.

SETTING

This investigation was conducted in 18 primary healthcare centres in Qazvin, Iran.

PARTICIPANT

Twenty-one female HCWs with at least 6 months of work experience and an average age of 34.4 years.

RESULTS

The participants identified six key elements as the stressful job demands including organisation's supervisory function, role characteristics, workload, job insecurity, client service challenges and perceived job content.

CONCLUSIONS

After organisational changes and development, HCWs were faced with role changes and increased workload. In addition, organisational supervision in terms of quantity and quality and lack of job security intensified the pressures. These factors led to the high level of stress among employees who dealt with people and those who perceived their job content as unfavourable. Perhaps teaching stress control skills and organisational support interventions can be useful to reduce and control stress among HCWs.

A scoping review and evaluation of instruments used to measure resilience among post-secondary students

As mental health problems continue to increase among post-secondary populations, the need to develop effective initiatives designed to bolster students’ resilience has increasingly been identified as a priority. Therefore, access to valid tools with which to measure the efficacy of these interventions is imperative. To date, a comprehensive assessment of existing instruments used to evaluate the construct of resilience among post-secondary student populations has not been conducted. The purpose of this study was to fill this gap by conducting a scoping review of literature detailing the use of resilience instruments and evaluating their quality based on suitability for use in the post-secondary setting and associated psychometric evidence. We identified a total of 78 records published between 2010 and 2022, extracting a total of 12 instruments. Using detailed criteria frameworks, each instrument was assessed in terms of suitability and quality of associated psychometric evidence for validity and reliability. The results of our study suggest that many of the instruments currently being used to assess resilience among post-secondary students may not be appropriate. The majority of the instruments included in our review were developed for use among general adult populations and not specifically designed for use in the post-secondary setting. Most instruments did not assess resilience in a comprehensive, holistic matter that addressed the ability to bounce back from adversity by drawing upon psychological, social, cultural, and environmental resources, as defined by recent research. Further, no instruments included in our review had published evidence in support of a complete psychometric analysis. The results of our evaluation suggest that the Connor-Davidson Resilience Scale (CD-RISC) is the most suitable instrument for measuring resilience among post-secondary populations due to its suitability, comprehensive assessment of the construct of resilience, and demonstrably strong psychometric properties for both the 25- and 10-item versions of the tool.

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There is a need for access to valid and appropriate tools with which to measure post-secondary students’ resilience.

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We identified a total of 12 instruments evaluating resilience among post-secondary student populations.

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The majority of the instruments were not designed for use in the post-secondary setting and were not comprehensive· We recommend the CD-RISC as the most suitable.

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We recommend the CD-RISC as the most suitable instrument for measuring resilience among post-secondary students.

Health Care Workers’ Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress

Background

Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial.

Objective

This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress.

Methods

This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale–Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence.

Results

Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=–0.31, 95% CI –0.47 to –0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=–0.24, 95% CI –0.40 to –0.08; P=.003), anxiety (b=–0.19, 95% CI –0.32 to –0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=–0.30, 95% CI –0.51 to –0.09; P=.005) but not for burnout (b=–0.19, –0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=–0.06, 95% CI –0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI –0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported.

Conclusions

An unguided digital MBSH intervention (Headspace) can reduce health care workers’ stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions.

Trial Registration

International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc

A causal model of job stress among Thai nurse-midwives

Objective

To test a causal model of job stress among nurse-midwives working in labor and delivery units in Thailand.

Methods

Random and convenience sampling was used to recruit 282 nurse-midwives with at least 6 months of work experience from 16 regional tertiary hospitals in Thailand. Data were collected from May to December 2020. Research instruments with good internal consistency reliability ranged from 0.83 to 0.91 including the Job Stress Scale and the Thai version of the Job Content Questionnaire (TJCQ). Descriptive statistics and a structural equation model were used for data analysis.

Results

Job demands were the strongest predictor of job stress. At the theoretical level, high job control plays a crucial role in directly reducing job stress. However, the present research provides contrary evidence to the theoretical predictions. When nurse-midwives perceive high job control, they perceive pressure to meet the expectations of their supervisors and colleagues. Therefore, high job control can contribute to job stress. Likewise, job support had an indirect effect on job stress among nurse-midwives through job control. The modified model fitted the empirical data (χ 2 = 57.76, df = 22, CMIN/df = 2.62, goodness of fit (GFI) =0.96, adjusted goodness of fit (AGFI) =0.91, comparative fit index (CFI) = 0.95, and root mean square error of approximation (RMSEA) = 0.07). The effects of job demands, job control, and job support on job stress among Thai nurse-midwives can explain 67% of the model's total variance for job stress.

Conclusions

Nurse-midwives who encounter high job demands and less control over their work control suffer from job stress. Job support does not directly affect nurse-midwives’ job stress but influences it through perceived job control. Strategies to decrease job stress among Thai nurse-midwives should focus on how to balance job demands, and enhance job control, and job support.

The effectiveness of adapted group mindfulness-based stress management program on perceived stress and emotion regulation in midwives: a randomized clinical trial

Background

Midwives' stress can have negative consequences on their emotional state, burnout, and poor quality of midwifery care. This study aimed to determine the effectiveness of an adapted mindfulness-based stress management program on perceived stress and the emotional regulation of midwives.

Methods

The study was a parallel randomized clinical trial on the midwives working in general hospitals of Zanjan, Iran. In this study, 121 midwives registered to participate based on the census sampling method were screened using a cut point of ≥ 28 in the Perceived Stress Scale (PSS). From the initial sample, 42 subjects had inclusion criteria assigned to two groups of control (n = 21) and intervention (n = 21) using online random allocation. The intervention group received an 8-week adapted mindfulness-based stress management program. This program emanates from the Kabat-Zinn's MBSR program, which has been adjusted according to the Iranian culture. The ANCOVA and repeated measure analysis of variance test were used to compare groups over time.

Results

The results showed that the group intervention effectively affected perceived stress (P = 0.001) and difficulty in emotion regulation during the post-intervention period (P = 0.001). Moreover, the interventions were effective in emotion regulation (P = 0.003), but it was not effective on perceived stress (P = 0.125) at the 3-month follow-up.

Conclusions

This adapted mindfulness-based program successfully reduced stress and increased emotion regulation strategies in midwives; however, the long-term outcomes of this treatment program need further consideration.

Nurses' job stress and its impact on quality of life and caring behaviors: a cross-sectional study

BACKGROUND

Nursing is considered a hard job and their work stresses can have negative effects on health and quality of life. The aim of this study was to investigate the correlation between job stress with quality of life and care behaviors in nurses.

METHODS

This cross-sectional survey design study was performed with the participation of 115 nurses working in two hospitals. The nurses were selected via the availability sampling method and data were collected by demographic characteristics, nurses 'job stress, quality of life (SF12), and Caring Dimension Inventory questionnaires.

RESULTS

The mean (SD) total scores of job stress, quality of life and caring behavior were 2.77 (0.54), 56.64 (18.05) and 38.23 (9.39), respectively. There was a statistically significant and negative relationship between total job stress scores with quality of life (r = -0.44, P < 0.001, Medium effect) and caring behaviors (r=-0.26, P < 0.001, Small effect). Univariate linear regression showed that job stress alone could predict 27.9% of the changes in the total quality of life score (β =-0.534, SE = 0.051, R^2adj = 0.279, P < 0.001) and 4.9% of the changes in the total score of caring behaviors (β =-0.098, SE = 0.037, R^2adj = 0.049 P < 0.001).

CONCLUSIONS

Job stress has a negative effect on the quality of life related to nurses' health. It can also overshadow the performance of care and reduce such behaviors in nurses, which may be one of the factors affecting the outcome of patients.

Occupational stress, dyadic adjustment and quality of work-life in married nurses: Moderating effects of dyadic coping

AIMS

This study aimed to evaluate whether stress communication and supportive dyadic coping moderate the effects of occupational stress on dyadic adjustment and the quality of work-life of nurses.

BACKGROUND

Nurses are at higher risk for occupational stress, work-family conflict, and the challenge of balancing job and family roles. However, in recent studies, the impact of dyadic coping strategies in dealing with work-family stress in those couples has not received adequate attention.

DESIGN

This study was a cross-sectional study.

METHODS

The research sample comprised 591 nurses recruited through announcements in hospitals and health centres in Iran between May 2018 and February 2019. They completed the Expanded Nursing Stress Scale, the Dyadic Coping Inventory, the Dyadic Adjustment Scale, and the Quality of Nursing Work Life questionnaire. Hierarchical regression was utilized.

RESULTS

Results indicated that there was a negative relationship between occupational stress and dyadic adjustment, and quality of work-life. Stress communication and supportive dyadic coping moderated the association between occupational stress and dyadic adjustment as well as the quality of work-life.

CONCLUSION

The current findings suggest that the nurses who use dyadic coping strategies to deal with occupational stress report a higher level of adjustment and quality of work-life.

Job stress and occupational burnout among clinical nursing teachers: A cross-sectional study

BACKGROUND

Clinical nursing teachers face conflicts and challenges while instructing nursing students in the clinical setting. They may be under job stress, which can lead to occupational burnout.

PURPOSE

This study investigated the current state and relationship between job stress and occupational burnout, as well as explore the significant predictors of occupational burnout among clinical nursing teachers.

METHODS

A cross-sectional study design and convenience sampling was conducted. A total of 205 clinical nursing teachers from 43 nursing schools in Taiwan. Used the Chinese version of the job content questions and occupational burnout inventory to collect data. Multiple linear regression was used to determine the predictors of occupational burnout.

RESULTS

The degree of perception of life stress by teachers was moderate, and occupational burnout was mild to moderate. Multiple regression analyses showed that perceived life stress and job stress were significant predictors of occupational burnout; perceived life stress was the strongest predictor of occupational burnout, explained 26.4% of the variance; and the workload explained 16.6% of the variance.

CONCLUSION

Perceived life stress and job stress influence occupational burnout. This study results may help administrators recognize the vulnerability of clinical nursing teachers to different stressors and develop strategies to improve occupational burnout.

Investigating the relationship between workplace stressors and caring behaviours of nursing staff in inpatient wards: A cross-sectional study

AIM

The present study aimed to investigate the effects of various job stressors on caring behaviours of nursing staff.

DESIGN

A cross-sectional nationwide study.

METHODS

This cross-sectional, descriptive-correlational study was conducted on 260 nurses employed in the inpatient wards of seven teaching hospitals in Tehran, Iran during December 2019-February 2020. The participants were selected via convenience sampling. Data were collected using a demographic questionnaire, the nursing stress scale and the caring behaviours inventory. Data analysis was performed in SPSS version 20 using descriptive statistics and linear regression analysis.

RESULTS

The results of regression analysis indicated that job stress is correlated with nurses' caring behaviours (β = -.36; p = .001). Factors such as workload (β = -.27; p = .001), uncertainty about patient treatment (β = -.26; p = .017) and lack of emotional preparation (β = -.20; p = .017) were the important stressors associated with nurses' caring behaviours.

CONCLUSIONS

According to the results, high levels of perceived job stress due to workload, uncertainty about patient treatment and lack of emotional preparation are associated with lower levels of nurses' caring behaviours.

IMPACTS

The findings of this study showed that to provide patients with optimal caring behaviours, hospital and nursing managers should design interventions to reduce nurses' job stressors, especially in terms of their interactions with their colleagues and physicians.

Job stress and its relationship with nurses' autonomy and nurse-physician collaboration in intensive care unit

AIMS

To determine nurses' job stress and its relationship with professional autonomy and nurse-physician collaboration in intensive care unit (ICU).

BACKGROUND

Low professional autonomy, high job stress and lack of nurse-physician collaboration can affect nursing care in ICU and the main reasons ICU nurses leave the occupation or transfer to other clinical units.

METHODS

A cross-sectional, correlational study was conducted on 398 nurses in teaching hospitals in Urmia, Iran, in 2020. Data were collected using the Dempster Practice Behaviors Scale, the Health and Safety Executive tool and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration.

RESULTS

The mean job stress (115.53 ± 12.42) and professional autonomy (102.19 ± 11.88) of ICU nurses were 'moderate', and nurse-physician collaboration (74.25 ± 5.10) was 'good'. There was a positive relationship between professional autonomy and job stress (r = .506) and nurse-physician collaboration (r = .242). Professional autonomy was a predictor of job stress in nurses (p < .000), and work experience in ICU can cause job stress in nurses (p = .024).

CONCLUSION

Increasing nurses' professional autonomy causes an increase in job stress and improves nurse-physician collaboration in ICU.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should implement practical strategies to improve nurses' autonomy, enhance nurse-physician collaboration and decrease their job stress.

The effect of occupational stress on marital satisfaction and mental health in Iranian nurses

BACKGROUND

Work and family life are the two basic components of the individuals' life and each one affects the other.

OBJECTIVE

This study aimed to investigate the relationship between occupational stress, mental health and marital satisfaction among Iranian nurses.

METHODS

A cross-sectional study was conducted on 200 randomly selected nurses. The 35 items hospital stress scale, Enrich Marital Satisfaction questionnaire and Scl-25 mental health questionnaire were used. Descriptive statistics, Pearson correlation coefficient, independent sample t-test and analysis of variance and regression analysis were used.

RESULTS

Inverse correlations were observed between the scores of job stress and mental health (r = -0.468, p = 0.001) and marital satisfaction (r = -0.517, p = 0.001). More than 0.74% of variation in marital satisfaction is explained by the components of occupational stress.

CONCLUSION

The results revealed that occupational stress plays a decisive role in nurses' marital satisfaction and mental health. Due to the destructive effects of occupational stress on the people's mental health, interpersonal relationships and on their efficacy in their job, establishment of some counseling services for nurses to be used by them periodically or by need, can help them to manage their stress level and better management of their family life problems. Moreover, in-service courses or workshops on stress management may help nurses to possess appropriate knowledge and skills on stress management.

Occupational stress and associated risk factors among nurses: a cross-sectional study

Background: Nursing can be demanding and stressful with occupational stress posing a serious threat to nurses and patient outcomes. Aims/Objectives: To determine the prevalence of nurses' occupational stress and its associated risk factors. Design: Cross-sectional survey design. Methods: Nurses in 115 tertiary-level hospitals in 13 provinces in Iran were surveyed from August 2016-December 2017. Demographic information and occupational stress were assessed. 5422 distributed questionnaires were distributed with 2895 of returned surveys analyzed. One-way ANOVA and multiple linear regression analyses identified risk factors for occupational stress. Results: Mean score for overall occupational stress was 3.48 indicating a stress level between moderate and high, with 78.4% of respondents reporting that their job was stressful. Nurses reported issues with shiftwork, staffing, pay, workplace discrimination, management, policy and excessive workloads as sources of occupational stress. Risk factors in the multivariate analysis for higher occupational stress were female gender (p = .002), being married (p = .008), having lower educational levels (p < .001), increased work hours (p <.001), and working in emergency (p = .025), general wards (p = .012) and teaching hospitals (p < .001). Conclusions: The high prevalence of occupational stress amongst nurses in Iran demonstrates the extent of the issue, with recent reforms not effectively addressing occupational stress. The risk factors identified allow for more targeted interventions.

Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses

Nurses remain at the forefront of patient care. However, their heavy workload as a career can leave them overworked and stressed. The demanding nature of the occupation exposes nurses to a higher risk of developing negative mental states such as depression, anxiety, and stress. Hence, the current study aimed to assess the prevalence and risk factors of these mental states in a representative sample of Australian nurses. The Depression Anxiety Stress Scale was administered to 102 nurses. Information about demographic and work characteristics were obtained using lifestyle and in-house designed questionnaires. Prevalence rates of depression, anxiety, and stress were found to be 32.4%, 41.2%, and 41.2% respectively. Binominal logistic regressions for depression and stress were significant (p = 0.007, p = 0.009). Job dissatisfaction significantly predicted a higher risk of nurses developing symptoms of depression and stress respectively (p = 0.009, p = 0.011). Poor mental health among nurses may not only be detrimental to the individual but may also hinder professional performance and in turn, the quality of patient care provided. Further research in the area is required to identify support strategies and interventions that may improve the health and wellbeing of nursing professionals and hence the quality of care delivered.