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Emergency Medicine Journal : EMJ Jul 2017Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which... (Review)
Review
INTRODUCTION
Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established.
METHODS
We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed. All articles written in English, French or Spanish were eligible for conclusion. Study quality was graded using a modified version of the Newcastle-Ottawa Scale.
RESULTS
Twenty-five full-text articles were eligible for inclusion in our systematic review. Most were of moderate quality, with two low-quality and two high-quality studies, respectively. While high demand and low job control were commonly featured, other studies demonstrated the role of insufficient support at work, effort-reward imbalance and organisational injustice in the development of adverse health and occupational outcomes. We found only one intervention in a peer-reviewed journal evaluating a stress reduction programme in ED staff.
CONCLUSIONS
Our review provides a guide to developing interventions that target the origins of stress in the ED. It suggests that those which reduce demand and increase workers' control over their job, improve managerial support, establish better working relationships and make workers' feel more valued for their efforts could be beneficial. We have detailed examples of successful interventions from other fields which may be applicable to this setting.
Topics: Burnout, Professional; Emergency Service, Hospital; Humans; Occupational Stress; Professional Autonomy; Workload
PubMed: 27729392
DOI: 10.1136/emermed-2016-205827 -
Occupational Medicine (Oxford, England) Oct 2013The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of... (Review)
Review
BACKGROUND
The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of employee health and productivity, and increased sickness absence. The HSE indicator tool aims to measure organizations' performance in managing the primary stressors identified by the HSE management standards.
AIMS
The aims of the study are to explore how the HSE indicator tool has been implemented within organizations and to identify contexts in which the tool has been used, its psychometric properties and relationships with alternative measures of well-being and stress.
METHODS
Studies that matched specific criteria were included in the review. Abstracts were considered by two researchers to ensure a reliable process. Full texts were obtained when abstracts met the inclusion criteria.
RESULTS
Thirteen papers were included in the review. Using factor analysis and measures of reliability, the studies suggest that the HSE indicator tool is a psychometrically sound measure. The tool has been used to measure work-related stress across different occupational groups, with a clear relationship between the HSE tool and alternative measures of well-being. Limitations of the tool and recommendations for future research are discussed.
CONCLUSIONS
The HSE indicator tool is a psychometrically sound measure of organizational performance against the HSE management standards. As such it can provide a broad overview of sources of work-related stress within organizations. More research is required to explore the use of the tool in the design of interventions to reduce stress, and its use in different contexts and with different cultural and gender groups.
Topics: Humans; Job Satisfaction; Occupational Diseases; Occupational Exposure; Occupational Health; Psychometrics; Safety Management; Stress, Psychological; United Kingdom; Work
PubMed: 23847137
DOI: 10.1093/occmed/kqt078 -
Journal of Pediatric Nursing 2021Psychological and symptom disturbances seriously affect hospitalized children's subjective experiences of hospitalization and their prognosis. We systematically reviewed... (Meta-Analysis)
Meta-Analysis Review
PROBLEM
Psychological and symptom disturbances seriously affect hospitalized children's subjective experiences of hospitalization and their prognosis. We systematically reviewed the effects of animal-assisted therapy (AAT) on pain, anxiety, depression, stress, blood pressure (BP), and heart rate (HR) in hospitalized children and teenagers.
ELIGIBILITY CRITERIA
A systematic review and meta-analysis were conducted using the English-language electronic databases PubMed, EMBASE, Web of Science, the Cochrane Library, Clinical Trials, Science Direct, EBSCOhost, Open Grey and Google Scholar, and the Chinese databases CNKI, Sinomed, Vip, and WanFang. These databases were searched through July 15, 2020.
SAMPLE
Eight studies, including four randomized controlled trials (RCTs) and four quasi-experimental studies were included, with a total of 348 participants.
RESULTS
Hospitalized children and teenagers with AAT had less pain (standardized mean difference = -0.49; 95% confidence interval [CI], -0.77 to -0.22; P < 0.001), lower systolic blood pressure (mean difference [MD] = -4.85; 95% CI, -9.50 to -0.21; P 0.04), higher diastolic blood pressure (MD = 4.95; 95% CI, 1.90 to 8.00; P = 0.001) than controls, while there was no significant difference in depression, anxiety, stress, or HR.
CONCLUSION
As an adjuvant to traditional treatment, AAT was beneficial for controlling pain and BP in hospitalized children and teenagers.
IMPLICATION
AAT may be an effective strategy for relieving pain and controlling BP in hospitalized children and teenagers, especially those with cancer. High-quality RCTs conducted or supported by nurses on the effects of AAT are needed.
Topics: Adolescent; Animal Assisted Therapy; Animals; Anxiety; Child; Child, Hospitalized; Humans; Neoplasms; Pain Management
PubMed: 33582447
DOI: 10.1016/j.pedn.2021.01.020 -
International Journal of Nursing Studies Sep 2021The contribution of work to positive mental health is increasingly apparent. Transition into the workplace causes a range of stressors for new graduate nurses who... (Review)
Review
BACKGROUND
The contribution of work to positive mental health is increasingly apparent. Transition into the workplace causes a range of stressors for new graduate nurses who experience both psychological wellbeing and illbeing in their first year of practice.
OBJECTIVE
To determine published prevalence, predictors, barriers and enablers of new graduate registered nurse wellbeing, work wellbeing and mental health.
DESIGN
Systematic review of quantitative research.
DATA SOURCES
Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Quantitative and mixed-methods studies were considered for inclusion if published in English from 2009 to 2019 reporting primary data analysis including new graduate nurses' wellbeing, work wellbeing and mental health.
REVIEW METHODS
Quantitative studies were systematically identified then screened and appraised against pre-determined inclusion criteria. Analysis was conducted by grouping according to analytical methods and results reported as a narrative synthesis.
RESULTS
Thirty-four studies were included. The quality of the evidence was variable with just a quarter of the studies being assessed as meeting the quality criteria on all nine measures. For the new graduate nurses prevalence of wellbeing, levels of resilience, optimism, and hope were found to be high. For work wellbeing, most reported higher job satisfaction by 12-months. For work illbeing, levels of burnout were moderately high, predominantly in terms of emotional exhaustion, and stress was initially high, particularly in terms of workload, but decreased over time. For the predictors, job satisfaction was positively predicted by structural empowerment and career satisfaction, and negatively predicted by co-worker incivility, supervisor incivility and emotional exhaustion. For work illbeing, stress was a positive predictor for intent to leave. Stress reductions were associated with momentary levels of high task mastery, social acceptance and role clarity.
CONCLUSIONS
For new graduate nurses, levels of emotional exhaustion, workload and stress were moderately high to high initially, decreasing over time as the graduate nurses' job satisfaction increased. Most studies focused on the nurses' intent to resign or stay and both psychological capital and work engagement positively predicted intent to stay whereas work stress positively predicted intent to resign. Resilience and group cohesion moderated the negative effects of some variables, thus may be potential enablers of work wellbeing. The standards of research reporting or design were generally sub-optimal according to quality indicators. Systematic review registration number: (CRD42020148812).
Topics: Burnout, Professional; Education, Nursing, Graduate; Humans; Job Satisfaction; Mental Health; Workplace
PubMed: 34218048
DOI: 10.1016/j.ijnurstu.2021.103997 -
Western Journal of Nursing Research Dec 2021Hospital nurses are at high risk of fatigue due to stressful work environments with heavy workloads and non-standard work schedules. This systematic review examined the...
Hospital nurses are at high risk of fatigue due to stressful work environments with heavy workloads and non-standard work schedules. This systematic review examined the relationship between hospital nurse fatigue and outcomes. Full-text English language quantitative studies published between January 2000 and July 2020 were included. A total of 22 articles were reviewed and synthesized. The findings were synthesized into three major categories: nurse outcomes, nurse-reported patient outcomes, and organizational outcomes. Some of the most commonly studied outcomes include nursing performance (n=3), sickness absence (n=3), and intention to leave (n=4). Fatigue was consistently associated with mental health problems, decreased nursing performance, and sickness absence. Many studies confirmed that nurse fatigue is negatively associated with nurse, patient-safety, and organizational outcomes. However, our findings highlight gaps in current knowledge and the need for future research using a longitudinal design and measuring additional outcomes to better understand the consequences of nurse fatigue.
Topics: Fatigue; Humans; Patient Safety; Personnel Staffing and Scheduling; Workload; Workplace
PubMed: 33554767
DOI: 10.1177/0193945921990892 -
BMC Public Health Mar 2017Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies -... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies - original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.
METHODS
A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.
RESULTS
Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.
CONCLUSION
While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.
Topics: Achievement; Adult; Australia; Burnout, Professional; Case-Control Studies; Europe; Female; Humans; Male; Mental Fatigue; New Zealand; North America; Occupational Exposure; Organizational Culture; Prospective Studies; Reward; Social Justice; Surveys and Questionnaires; Workload; Workplace
PubMed: 28302088
DOI: 10.1186/s12889-017-4153-7 -
Journal of Advanced Nursing Jun 2018The aim of this study was to describe and summarize workplace characteristics of three nursing generations: Baby Boomers, Generations X and Y. (Comparative Study)
Comparative Study Review
AIMS
The aim of this study was to describe and summarize workplace characteristics of three nursing generations: Baby Boomers, Generations X and Y.
BACKGROUND
Generational differences affect occupational well-being, nurses' performance, patient outcomes and safety; therefore, nurse managers, administrators and educators are interested increasingly in making evidence-based decisions about the multigenerational nursing workforce.
DESIGN
Mixed-method systematic review.
DATA SOURCES
Medline, CINAHL, PsycINFO and Scopus (January 1991-January 2017).
REVIEW METHODS
(1) The Joanna Briggs Institute's method for conducting mixed-method systematic reviews; (2) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and (3) the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. The studies' methodological quality was assessed with the Mixed-Methods Appraisal Tool. Quantitative and mixed-method studies were transformed into qualitative methods using a convergent qualitative synthesis and qualitative findings were combined with a narrative synthesis.
RESULTS
Thirty-three studies were included with three main themes and 11 subthemes: (1) Job attitudes (work engagement; turnover intentions, reasons for leaving; reasons, incentives/disincentives to continue nursing); (2) Emotion-related job aspects (stress/resilience; well-being/job satisfaction; affective commitment; unit climate; work ethic) and (3) Practice and leadership-related aspects (autonomy; perceived competence; leadership relationships and perceptions). Baby Boomers reported lower levels of stress and burnout than did Generations X and Y, different work engagement, factors affecting workplace well-being and retention and greater intention to leave compared with Generation Y, which was less resilient, but more cohesive.
CONCLUSION
Although several studies reported methodological limitations and conflicting findings, generational differences in nurses' job attitudes, emotional, practice and leadership factors should be considered to enhance workplace quality.
Topics: Adult; Age Factors; Aged; Attitude of Health Personnel; Burnout, Professional; Cohort Effect; Female; Humans; Job Satisfaction; Male; Middle Aged; Nursing Staff, Hospital; Personnel Turnover; Workplace
PubMed: 29424038
DOI: 10.1111/jan.13538 -
Journal of Minimally Invasive Gynecology Feb 2019Enhanced recovery after surgery (ERAS), or "fast-track" protocol, aims to minimize the physiologic stress of surgery and optimize the rehabilitation of patients....
Enhanced recovery after surgery (ERAS), or "fast-track" protocol, aims to minimize the physiologic stress of surgery and optimize the rehabilitation of patients. However, there is limited data in obstetrics and gynecology. We reviewed the published literature on ERAS programs in gynecology to evaluate the outcomes and potential key elements for a successful program. Fifty studies were evaluated. We recommend preoperative counseling to the patient, no bowel preparation, an opioid-sparing multimodal approach to pain management, goal-directed fluid management, minimally invasive surgery when possible, and early mobilization and feeding. This is a multidisciplinary team effort and requires active patient participation in the process.
Topics: Ambulatory Surgical Procedures; Analgesics, Opioid; Clinical Protocols; Counseling; Early Ambulation; Epidemiologic Methods; Female; Fluid Therapy; Genital Diseases, Female; Humans; Hysterectomy; Laparoscopy; Nutritional Support; Pain Management; Pain, Postoperative; Patient Care Planning; Patient Care Team; Perioperative Care
PubMed: 30580100
DOI: 10.1016/j.jmig.2018.12.010 -
Complementary Therapies in Medicine Aug 2020Virtual reality (VR) is being used more and more often as a therapeutic tool in psychology or psychiatry. In recent years, VR interventions appear more extensively also...
BACKGROUND
Virtual reality (VR) is being used more and more often as a therapeutic tool in psychology or psychiatry. In recent years, VR interventions appear more extensively also in disorders such as depression, anxiety and phobia. However, there has yet to be a comprehensive synthesis and critical review of the literature to identify future directions to advance the field in this area.
OBJECTIVES
To broadly characterize the literature to date on the application of VR in psychiatric disorders by conducting a systematic review of reviews, describe the limitations of existing research, suggest avenues for future research to address gaps in the current literature and provide practical recommendations for incorporating VR into various treatments for psychiatric disorders.
METHODS
PubMed and Web of Science databases were searched for reviews on VR use in psychiatric disorders (e.g. various pain perceptions, post-traumatic stress disorder, phobias, attention deficit hyperactivity disorder, psychosis, depression). The methodological quality of each literature review was assessed using AMSTAR.
RESULTS
The original search identified 848 reviews, of which 70 were included in the systematic review of reviews. Broadly, the literature indicates that various VR interventions could be useful in different psychiatric disorders.
CONCLUSION
This study provides evidence supporting the positive impact of VR therapy in psychiatric disorders. However, the impact is defined differently according to the studied area. Nevertheless, due to the continuous development of VR hardware and software, it is essential to conduct further research in the area of psychiatric disorders, especially as no review has concluded that VR does not work.
Topics: Humans; Mental Disorders; Pain Management; Systematic Reviews as Topic; Virtual Reality Exposure Therapy; Review Literature as Topic
PubMed: 32951730
DOI: 10.1016/j.ctim.2020.102480 -
International Journal of Nursing Studies Jul 2015The transition from student to newly qualified nurse can be stressful for many newly qualified nurses who feel inadequately prepared. A variety of support strategies to... (Review)
Review
BACKGROUND
The transition from student to newly qualified nurse can be stressful for many newly qualified nurses who feel inadequately prepared. A variety of support strategies to improve the transition process have been reported across the international literature but the effectiveness of such strategies is unknown.
OBJECTIVES/AIM
To determine the effectiveness of the main strategies used to support newly qualified nurses during the transition into the clinical workplace and, where identified, evaluate the impact of these on individual and organisational outcomes.
DESIGN
Systematic review.
DATA SOURCES
A search of electronic databases to identify published studies (CINAHL, MEDLINE, British Nursing Index, Cochrane Library, EMBASE, PsychLit, PsychINFO, PsychARTICLES, Web Of Science, EBM Reviews, BioMed, TRIP, ERIC, SCOPUS (January 2000-April 2011) was conducted. Relevant journals were hand-searched and reference lists from retrieved studies were reviewed to identify any further studies. The search was restricted to English language papers. The key words used were words that described new graduate nurses and support strategies (e.g. internship, residency, orientation programmes).
REVIEW METHODS
The inclusion criteria were quantitative studies that investigated the effectiveness of support strategies for newly qualified graduate nurses. Studies that involved students in their final year of graduate study were excluded (for example extern programmes). Extraction of data was undertaken independently by two reviewers. A further two reviewers assessed the methodological quality against agreed criteria.
RESULTS
A total of 8199 studies were identified from the database search and 30 met the inclusion criteria for the review. The evidence suggests that transition interventions/strategies do lead to improvements in confidence and competence, job satisfaction, critical thinking and reductions in stress and anxiety for the newly qualified nurse.
CONCLUSIONS
This systematic review demonstrates the beneficial effects of transitional support strategies for newly qualified nurses from the perspective of the new nurse and their employer. The overall impact of support strategies appears positive, irrespective of the type of support provided. This may suggest that it is the organisations' focus on new graduate nurses that is important, rather than simply leaving them to acclimatise to their new role themselves. Future research should involve well designed randomised controlled trials with larger sample sizes, using more objective and reliable outcome measures.
Topics: Developed Countries; Mentors; Nursing Staff; Personnel Turnover; Preceptorship; Students, Nursing
PubMed: 26001854
DOI: 10.1016/j.ijnurstu.2015.03.007