Stress among nurses working in an acute hospital in Ireland Teresa Donnelly

Key words: Stress ■ Critical and non-critical practice areas ■ Redeployment ■ Staffing levels ■ Influencing factors

T

he word ‘stress’ derives from the Latin stringere which means to ‘draw tight’ (Cooper and Dewe, 2005). Stress is defined as ‘any factor or event that threatens a person’s health or adversely affects his or her normal functioning’ (Blacks Medical Dictionary, 2005: 679). It can be either harmful or damaging (distress) or positive and beneficial (eustress) (Billeter-Koponen and Freden, 2005). Stress theory was revolutionised by Hans Selye, who developed the gas adaptation syndrome (GAS) model that suggested stress is a major cause of disease due to chemical changes. Seyle outlined in three phases the effects of stress on the body. The alarm stage, where danger is identified and the body releases hormones to deal with it; damage may be caused to vital organs as a result. The next stage is resistance, where the body attempts to restore balance. If stress continues, the body’s defences become weakened and it moves into the final stage of exhaustion, at which stage the body’s ability to resist is gone. This is the most serious stage and is often known as ‘burnout’. Chronic stress damages nerve cells in tissues and organs, thinking and memory may be impaired

Teresa Donnelly, Clinical Nurse Manager 2, General Theatre, Sligo Regional Hospital, Ireland Accepted for publication: June 2014

Methods Design The aims of this study were to identify perceived stressors for qualified nurses in the critical and non-critical practice

746

British Journal of Nursing, 2014, Vol 23, No 13

British Journal of Nursing 2014.23:746-750.

© 2014 MA Healthcare Ltd

Abstract

Stress among nurses leads to absenteeism, reduced efficiency, longterm health problems and a decrease in the quality of patient care delivered. A quantitative cross-sectional study was conducted. The study’s aim was to identify perceived stressors and influencing factors among nurses working in the critical and non-critical care practice areas. A convenience sample of 200 nurses were invited to complete the Bianchi Stress Questionnaire. Information was collected on demographics and daily nursing practice. Findings indicated that perceived stressors were similar in both groups. The most severe stressors included redeployment to work in other areas and staffing levels. Results from this study suggest that age, job title, professional experience and formal post-registration qualifications had no influence on stress perception. These results will increase awareness of nurses’ occupational stress in Ireland.

and there is a tendency towards anxiety and depression. The nervous system may also be affected, leading to high blood pressure, heart disease, rheumatoid arthritis and other stressrelated illness (Seyle, 1978). Nursing professionals have long faced extraordinary stresses, many connected with the nursing profession itself, extended working hours, giving emotional support to patients and dealing with environments that are physician-controlled (Gelsema et al, 2006). It is suggested that 40% of hospital nurses suffer from stress (Galbraith and Brown, 2010). According to Milliken et al (2007), stress contributes to inefficiency, high turnover of staff, sickness, absenteeism, decreased quality of care and poor job satisfaction. Oliver and Lewis (2009) state that stress reduces productivity by affecting the ability of staff to perform their roles effectively and increasing absence due to stress-related illness. A 2012 survey showed that 60% of nurses said they were experiencing more stress than a year ago; 42% described themselves as ‘burnt out’ (Dean, 2012). Work-related stress is cited as a contributing factor to the difficulty in the recruitment and retention of nursing staff (Deary et al, 2003). Stress has a negative outcome on recruitment and retention of nurses (Watson, 2008), and stress and burnout are the main personal reasons why nurses leave the profession (Tran et al, 2010).Wu et al (2012) highlight the problems of retention and attrition among graduate nurses. They state that stress is a major contributing factor. By the year 2020, the size of the registered nurse workforce is forecast to be 20% below the projected requirements worldwide. Stress is recognised as a major factor implicated in the nursing shortage (Shirey, 2006). There is now a greater need for workforce flexibility and sharing of services. Working in this type of environment is potentially very stressful (McCarthy, 2010). McIntosh and Sheppy (2013) suggest that while stress is particular to the individual, it is possible that nurses may find some settings more stressful than others. The author’s interest in carrying out a study on stress has been generated by reading the literature and from personal experience of working in potentially stressful situations due to reduced resources, such as staff shortages, poor skill mix and increased work demands. The interest was intensified by observing colleagues’ stressed behaviour in practice and the high rate of absenteeism due to illness. Informal discussion with colleagues also suggests stress is prevalent.

RESEARCH areas; to rate the level of this stress using a Likert scale; and to compare findings from both areas. Age, job title, professional experience and post-registration formal academic qualifications of the cohort were investigated to distinguish if they had an influence on stress perception. A quantitative, cross-sectional survey research design was used. The purpose of quantitative research is to measure (Cormack, 2000). A survey model is relevant to the researchers’ study, as the survey obtains information to study associations and prevalence between variables and to determine trends to measure certain phenomena in the population being investigated. As such, it is free from interpretative bias (Bowling, 2009).

Sample Ethical approval was granted by the local research ethical committee. The author used the guidance for nurses and midwives regarding ethical conduct of nursing and midwifery research as a framework to guide the research process (An Bord Altranais, 2007). A two-stage cluster sampling was used: first, the selection of seven different work areas; second, a convenience sample of qualified nurses from these areas. The target population for this study was nurses working in the critical care practice settings, which were to include the intensive care unit (ICU), emergency department (ED) and operating room (OR), and nurses working in the non-critical care practice settings, including the medical, surgical, paediatric and day-service wards. A sample of 200 was identified. Data were collected using the Bianchi stress questionnaire tool. Permission was sought and granted from the author to use this tool (Bianchi, 2008).

Data tool The data collection tool consisted of questions on the participants’ demography in addition to 19 questions that describe their daily nursing practice. Participants had to rate each item as to how stressful they perceived it to be, using a 7-point Likert scale (1=no stress to 7=extreme stress). Validity of the questionnaire was assessed by content and face validity. Expert opinion was sought from academic and professional staff: two lecturers from the local university who supervise research and a member of the local research ethics committee were presented with the questionnaire for validation. Reliability was determined by the test-retest method where the questionnaire was presented to eight randomly selected participants who were asked to fill it in. After a period of 2 weeks, the same people were asked to fill in the questionnaire again.

Table 1. Mean scores for perceived stressors in the critical and non-critical practice areas Potential perceived stressors Staffing levels Skill mix on duty Admin duties

n

Mean

SD

SME

Critical

86

4.82

1.677

0.181

Non-critical

49

5.92

1.412

0.202

Critical

86

4.22

1.582

0.171

Non-critical

49

4.65

1.798

0.257

Critical

86

5.01

1.818

0.196

Non-critical

49

5.47

1.697

0.242

Planning, coordinating, delegating and evaluating

Critical

86

3.9

1.659

0.179

Non-critical

49

3.71

1.72

0.246

Communicating with patient and family

Critical

86

3.26

1.639

0.177

Non-critical

49

4.2

1.947

0.278

Provision of quality care

Critical

86

4.33

1.792

0.193

Non-critical

49

4.78

1.806

0.258

Critical

86

3.62

1.66

0.179

Non-critical

49

3.59

2.13

0.304

Communicating with Critical departments outside your unit Non-critical

86

4.08

1.77

0.191

49

4.08

1.73

0.247

Death of a patient

Critical

86

5.21

1.729

0.186

Participating in audit

Non-critical

49

4.92

1.847

0.264

Communicating with nursing colleagues

Critical

86

3.31

1.513

0.163

Non-critical

49

3.61

1.669

0.238

Communicating with multidisciplinary team

Critical

86

4.33

1.627

0.175

Non-critical

49

4.8

1.708

0.244

Communicating with management

Critical

86

4.52

1.74

0.188

Non-critical

49

4.9

1.735

0.248

Complying with mandatory training

Critical

86

3.85

1.85

0.2

Non-critical

49

4.18

1.856

0.265

Keeping up to date with developments

Critical

86

4.9

1.756

0.189

Non-critical

49

4.69

1.917

0.274

Redeployment to other areas

Critical

86

5.49

1.8

0.194

Non-critical

49

5.49

1.647

0.235

Critical

86

4.78

1.533

0.165

Achieving work-life balance

Non-critical

49

5.47

1.569

0.224

Carrying out duties in time allowed

Critical

86

4.47

1.767

0.191

Non-critical

49

5.08

1.788

0.259

Access to equipment

Critical

86

4.22

1.791

0.193

Non-critical

49

4.8

1.915

0.274

Critical

86

4.17

1.777

0.192

Non-critical

49

4.17

1.872

0.267

Training to use equipment

SD=standard deviation, SME=standard mean error, n=135

Data collection

© 2014 MA Healthcare Ltd

Between March 2012 and July 2012, 200 eligible participants were sent an envelope containing the questionnaire, a stamped addressed envelope (SAE) and and information leaflet about the study. They were invited to complete the questionnaire in their own time and return it in the SAE.

Analysis Data were analysed with the computer software package SPSS (Statistical Package for the Social Sciences, Version 18). Descriptive statistics were used to describe the properties of

the sample and its strata. To explore differences, distinctions were made between the following subgroups: ■■ Nurses working in the critical care practice areas and nurses working in the non-critical care practice areas ■■ Nurses in the age groups 25–35, 36–50 and 51+ ■■ Qualifications of staff, staff nurse, senior staff nurse or clinical nurse manager ■■ Years of experience of nurses:

Stress among nurses working in an acute hospital in Ireland.

Stress among nurses leads to absenteeism, reduced efficiency, long-term health problems and a decrease in the quality of patient care delivered. A qua...
568KB Sizes 3 Downloads 6 Views