Coping and Caregiving: Leveraging Environmental Design to Moderate Stress Among Healthcare Workers in the Emergency Department Setting

BACKGROUND

Due to exposure to overwhelming work stressors, approximately half of emergency department (ED) physicians and nurses experience burnout, leading to lower productivity, lower quality of care, higher risk of medical errors, higher rates of absenteeism, and eventually turnover. Growing evidence suggests that the physical environment can be leveraged to support healthcare workers' well-being.

OBJECTIVES

This study aimed to identify (1) self-care behaviors that healthcare workers engage in to help them cope with job-related stress, (2) where they engage in those behaviors, (3) attributes of the built environment that may support coping behaviors.

METHODS

A mixed-methods study was conducted in three EDs, using online questionnaires (n = 85) and interviews (n = 20).

RESULTS

Job-related stress was derived from interruptions, workload and inability to take breaks, insufficient workspace, lack of privacy, unpredictability of EDs, and security concerns. Talking with a colleague, getting something to eat or drink, listening to music, and taking a walk were considered destressing activities. The bathroom was considered a place for destressing by the majority of participants, followed by outside areas, physician-only areas, and care team stations. Supportive environmental features included sufficient workspace, maximized privacy, reduced noise and clutter, controlled temperature and lighting, spaces for decompressing, spaces for documentation, close-by breakrooms with enough eating space and massage chairs, chairs with back support, standing desks, food options, and convenient bathrooms.

CONCLUSIONS

Design decisions play an important role in supporting stress reduction among healthcare workers. This study provides several strategies to achieve this aim.

Perceived Utilization of Leadership Styles Among Nurses

Background

Nurses´ perceptions of leaders´ leadership styles has a significant impact on their well-being. Effective leadership in health care is crucial for improving and enhancing the effectiveness of health care systems. This study aimed to assess the perceived utilization of leadership styles among nurses at Jimma town public health facilities, Ethiopia.

Methods

This facility-based cross-sectional study was conducted with 403 nurses. Data were collected through a self-administered structured questionnaire. Data were entered into Epi-Data version 4.6 and then exported to SPSS version 25. The strength of association was described using unstandardized adjusted β with a 95% confidence interval (CI) and p-value <0.05.

Results

Of the 422 participants, 403 completed and returned the questionnaire correctly, thus achieving a response rate of 95.5%. Staff nurses perceived that their head nurses fairly often or commonly used transformational leadership styles, with a mean of 2.77±0.60. The multivariable linear regression analysis model indicated that there was a positive relationship between perceived leadership style and gender, overall organizational commitment, overall job-related stress, overall innovative work behavior, and overall leadership practice. However, there was a negative relationship between perceived leadership style and nurses who had not received previous training on leadership.

Conclusion

This study highlights that transformational leadership is a commonly utilized leadership style by leader nurses. Effective and balanced use of various leadership styles requires knowledge (training), organizational commitment, and innovative work behavior from both leaders and staff nurses. Therefore, a transformational leadership style is key to achieving organizational goals and increasing staff nurses' productivity.

Psychoeducational interventional programme during the COVID-19 pandemic for nurses with severe occupational stress: A randomized controlled trial

BACKGROUND

Occupational stress is generally acknowledged as a major issue in the health sector that may have a detrimental impact on nurses' psychological and physical health, particularly during the COVID-19 epidemic.

AIM

This study evaluated the effectiveness of a psychoeducational interventional programme in decreasing occupational stress and improving coping methods among nurses during the COVID-19 pandemic.

METHODS

This study used a cluster-randomized approach. Data were collected from 80 nurses working in two public health-care centres from May to August 2020 in Jordan. Two centres were assigned randomly to the intervention and control groups. The psychoeducational programme was delivered to the intervention group in six sessions over 6 days for 2 weeks. The collected data were analysed using SPSS through descriptive and inferential statistics. Occupational stress and coping strategies were measured.

RESULTS

Repeated-measures analysis of variance (ANOVA) indicated that the degrees of occupational stress and coping strategies significantly differed between study groups over the three points of data collection.

CONCLUSION

This psychoeducational interventional programme is a valuable noninvasive method that can improve individual coping strategies to manage stress in practice during the COVID-19 pandemic.

Secondary School Athletic Trainers' Experiences With Organizational Conflict: A Comparison Across Employment Models

CONTEXT

Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood.

OBJECTIVE

To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics.

DESIGN

Cross-sectional study.

SETTING

Secondary school athletics.

PATIENTS OR OTHER PARTICIPANTS

Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8).

MAIN OUTCOME MEASURES

Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest.

RESULTS

We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040).

CONCLUSIONS

Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Tumorpatienten und onkologisches Personal während der Pandemie

Die seit 2020 vorherrschende Ausbreitung des SARS-CoV‑2 („severe acute respiratory syndrome coronavirus type 2“) hatte weitreichende Folgen. Auch für onkologische Patienten und die in der Behandlung Helfenden in Deutschland kam es zu unvorhersehbaren Veränderungen. Ziel der hier vorgestellten Projekte war es, die Auswirkungen im Verlauf der Pandemie für diese Menschen näher zu beobachten. Genutzt wurden hierfür Onlinefragebögen und Interviews, die zu den Coronawellen in den Jahren 2020 und 2021 freigeschaltet bzw. durchgeführt wurden. An der Befragung nahmen insgesamt knapp 1000 Patienten und 900 professionelle Helfer teil. Zusätzlich wurden 20 Personen interviewt. Die Ergebnisse lassen erkennen, dass sich die klinische Versorgung über die Zeit an die neuen Anforderungen anpasste. Aspekte wie Besuchsverbote oder die Maskenpflicht wurden normal. Gleichzeitig stiegen die Frustration und Überbelastung aufseiten des onkologischen Personals von Welle zu Welle deutlich. Nachfolgende Projekte zeigten darüber hinaus, dass bei den Patienten bereits mit der zweiten Welle mentale Copingstrategien sowie körperliche Aktivität nachließen. Um dem etwas entgegenzustellen, wurden virtuelle Projekte ins Leben gerufen, die wissenschaftlich fundierte Wissensvermittlung und Bewegung beinhalteten. Die dargestellten Verläufe sind alarmierend. Sie sprechen für die Dringlichkeit, einerseits zu verhindern, dass Helfer das Gesundheitssystem verlassen, und andererseits sie stärker zu unterstützen sowie Entlastung zu schaffen. Patienten müssen auch digital weiter geschult und vor dem Alleingelassenwerden bewahrt werden.

Understanding key worker experiences at an Australian Early Childhood Intervention Service

The delivery of family-centred practice (FCP) within Early Childhood Intervention Services (ECISs) for young children with a disability or development delay conceptualises that children's learning environments, parenting, family and community supports intersect to have the greatest impact on the developing child. The transdisciplinary key worker model is considered a best-practice approach within ECISs whereby staff work collaboratively across disciplinary boundaries to plan and implement services for children and their families. Research suggests families who have a key worker have better relationships with services, fewer unmet needs, better morale, more information about services, higher parental satisfaction and more parental involvement than those not receiving this service. Using a phenomenological qualitative design this study sought to understand transdisciplinary key workers' perspectives regarding the strengths and challenges to undertaking their role in providing services to children and families accessing an ECIS at a major disability service organisation, in light of the changing policy reform during the roll out of the National Disability Insurance Scheme in Australia. Purposive sampling was used to recruit key workers (n = 13) to participate in semi-structured interviews during 2015. Data were analysed using an inductive, thematic approach. Results revealed four main themes that impact on the effectiveness of key workers' service provision. These are broadly categorised as (a) Engagement with the workplace, (b) Engagement with clients, (c) Professional capacity and (d) Staff Wellbeing. The findings aligned with previous studies identifying sources of support and stress for disability services staff. They also provided new insights into key workers' lack of confidence in addressing parental mental health issues, despite operating under a family-centred approach. These findings informed the development of an intervention trial and evaluation to improve support for parent and staff wellbeing within a Victorian Disability Service with the aim of building their capacity to support children with a disability.

Individual-Level Interventions for Decreasing Job-Related Stress and Enhancing Coping Strategies Among Nurses: A Systematic Review

Background: Nurses are facing unprecedented amounts of pressure because of the ongoing global health challenges. Improving nurses' resilience to job-related stress and enhancing their strategies to cope effectively with stressors are key issues facing many health care institutions during the COVID-19 pandemic. This literature review aimed to: a) provide a thorough overview of individual-level interventions for stress management among nurses, b) identify measurement tools utilized to evaluate nurses' stress level, and c) provide the best evidence-based recommendations for future research and practice adapted to the current restrictions. Design: Systematic review. Data Sources: Studies published between January 2000 and October 2020 were retrieved from the following sources: EBSCOhost, Dortmund University Library, PubMed, Medline, Google Scholar, Applied Nursing Research, and reference lists from relevant articles. Review methods: Individual-level interventions with a control group or a placebo intervention were included in the final sample. Primary outcome was defined as a change in individual stress level or stress symptoms which were measured by objective or subjective instruments with evidence of validity. Articles published in English or German were included in the present review. Results: In total, 27 relevant studies were included into the current review. There are some indications that technology-delivered interventions with relaxation and stress management interventions comprising cognitive-behavioral components might be effective in decreasing stress among nurses and improving their well-being. Furthermore, although there were some attempts to collect objectively measured parameters for assessing the primary outcome of stress, the majority of the interventions utilized self-reported stress scales. Conclusion: A wide range of interventions are available for nurses. However, it is of utmost importance to develop and implement stress management programs that are conveniently accessible in the workplace and above all, meet the current restrictions for minimizing human contacts. To this end, innovative interventions delivered through digital technology, such as virtual reality, seem to be a promising solution for combating the detrimental impact of stress on nurses. Special attention should be also paid to applying standardized objective measurement tools to allow the assessment of sensitive physiological indices and the generalizability of scientific knowledge.

Development Of a Chronic Stress Diagnosis

This study discusses a novel diagnosis, "stress- related exhaustion disorder", which was introduced in Sweden in 2005. An International Classification of Diseases 10^th revision (ICD-10) code, F43.8A, was specified for exhaustion disorder. Since then, there has been a remarkable increase in the number of patients diagnosed with exhaustion disorder in Sweden. The scientific basis of the diagnosis, and the putative mechanisms behind its increase, are discussed. It is hypothesized that the following factors may have promoted the increase in exhaustion disorder diagnosis: (i) the widespread perception of exhaustion disorder as a medical condition with physiological impairment of the endocrine and nervous systems, caused by external stressors; (ii) provision of healthcare resources and social insurance benefits for exhaustion disorder, without having firm evidence or guidelines on its management; (iii) highly inclusive diagnostic criteria for exhaustion disorder that overlap with the criteria for several other diagnoses (depression, anxiety disorders, chronic pain disorders), leading to possible bias towards exhaustion disorder diagnosis. The increase in exhaustion disorder does not necessarily reflect an increased stress-related morbidity in society. It is also important to consider factors related to the concept of stress as a disease, the availability and organization of healthcare and social insurance benefits, and diagnostic bias.

The effects of the type of delivery of cognitive-behavioral therapy for healthcare workers: A systematic review

OBJECTIVE

The aim of this literature review is to assess the extent of knowledge of the effectiveness of cognitive-behavioral therapy (CBT) for healthcare workers by type of delivery.

METHODS

The study examined relevant literature published between 2009 and 2020 using searches of four scientific databases: PubMed, CINAHL, Embase, and PsycINFO.

RESULTS

For work stress, work-related outcomes, and mental and musculoskeletal problems, the effectiveness of face-to-face (FTF) interventions were confirmed, whereas, for stress and insomnia, the effectiveness of non-face-to-face (NFTF) interventions was confirmed. FTF interventions were proven to make a significant difference to the outcome of the goal; however, their effects were not clearly distinguished from those of NFTF interventions.

CONCLUSION

Results of this review highlight the lack of research aimed at establishing the effectiveness of NFTF interventions. In addition, further research is needed on the long-term effectiveness of the intervention process and perception of participants and clinicians on group delivery interventions.

The Relationships Between Oncology Nurses' Attitudes Toward a Dignified Death, Compassion Competence, Resilience, and Occupational Stress in South Korea

OBJECTIVES

In recent years, South Korea has become more concerned about a dignified death and the 'well-dying' law has been enacted. Oncology nurses' perceptions of death are crucial in maintaining dying patients' sense of dignity; fostering their physical, mental, and spiritual quality of life; and ensuring that they die a comfortable death. This study accordingly examined the relationships between attitudes towards a dignified death, compassion competence, resilience, and occupational stress to provide basic data to promote better attitudes towards death among oncology nurses in South Korea.

DATA SOURCES

This study, conducted between 2 to 31 January 2018, adopted a descriptive cross-sectional design. Oncology nurses (N = 329) participated, and the differences in their attitudes towards a dignified death correlating to their demographic and work-related characteristics were analysed using t-tests and analyses of variance. Pearson's correlations were used to examine the relationships between nurses' attitudes towards a dignified death, compassion competence, resilience, and occupational stress.

CONCLUSION

Participants' attitudes towards a dignified death were weaker than those of the general population but stronger than those of non-oncology nurses. Attitudes towards a dignified death were significantly correlated with compassion competence and resilience-traits that appear to enable nurses' efficient response to various stressful situations.

IMPLICATIONS FOR NURSING PRACTICE

Educational programmes should promote nurses' compassion competence and resilience. Nurses should receive death-related education to reduce the stress that arises from providing end-of-life care and enhance their attitudes towards a dignified death.

Psychometric properties of the short-form Chinese Community Nurses Stress Scale: A cross-sectional study

Job-related stress had adverse effects on both patients and community nurses. To evaluate stress, an effective and reliable instrument was needed. The aim of this study was to develop a short-form Chinese Community Nurse Stress Scale and examine its psychometric properties.A cross-sectional study was conducted. A total of 969 community nurses were selected from 56 community centers/stations in Sichuan Province. The socio-demographic data and job stress assessed by the Chinese Community Nurse Stress Scale (CNSS) were collected. After randomly splitting the sample into group 1 and group 2, exploratory and confirmatory factor analysis were carried out to shorten the scale and test its reliability and construct validity.There were no significant differences in socio-demographic variables between group 1 (n = 488) and group 2 (n = 481). During exploratory factor analysis, 4 factors were selected, including management and interpersonal relationships (8 items), patient care (7 items), environment and resources of work (6 items), and career promotion (4 items), which explained 62.66% of all variance. Cronbachs α coefficient of the short-form CNSS was 0.94, and the cross-sample validity test supported the best fit model for this 25-item CNSS.The results in this study supported that the 25-item CNSS had a good reliability and validity when it was administrated to Chinese community nurses.

[The role of safety climate and the relationship with job satisfaction: an exploratory study across three different occupational contexts.]

OBJECTIVES

This study examined the role of the "safety climate", or the organization's attention to health and safety of workers, and of job demand and resources in relation with job satisfaction. Wellbeing at work is a topic of growing interest, in line with the legislation and the programs on health and safety of workers and management and the evaluation of psychosocial risks. Several studies show that organizational actions concerning health and safety can be an indicator of the attention to employees' wellbeing, even if studies about the relationship between safety climate and some psychosocial outcomes are scant.

METHODS

The study analysed the relationship between job demand, job resources, safety climate and job satisfaction in three different occupational contexts (public authority, N = 224; social care organization, N = 115; pharmaceutical company, N = 127); workers were divided into groups based on the risk level appeared in the objective assessment of work-related stress, in order to identify differences. The self-report questionnaire gathered information about: job satisfaction, work efforts, supervisors' support, colleagues support, safety climate (α between .72 and .93). Data analysis provided: Cronbach α, analysis of variance, correlations, stepwise multiple regressions.

RESULTS

The results showed that job satisfaction (R2 between .23 and .88) had a negative relationship with efforts and a positive relationship with job resources and safety climate.

CONCLUSIONS

It emerges the importance of safety climate: to support and promote wellbeing at work, organizations could endorse training and information programs on health and safety for all workers and management, not only for professional groups with high-risk level. Future studies could explore the relation between safety climate and other outcomes, such as emotional exhaustion or objective indicators of organizational health (e.g. absenteeism, accidents, etc.).