Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Association of social skills with psychological distress among female nurses in Japan

Nursing is a highly stressful occupation. Because nursing work involves interaction with patients and colleagues, competence in social skills may be a key issue in stress management among nurses. However, there are very few studies among nurses focused on social skills together with social support, both of which are important aspects of job stress. The aim of this study was to examine the interrelationships between social skills and social support with job stressors, problem-solving coping, and psychological distress among Japanese nurses. Data from a self-administered questionnaire of 1,197 female nurses who worked for 5 general hospitals in Japan were analyzed. Covariance structure analysis with structural equation modeling techniques showed that social skills and social support were positively related to each other, while they were negatively associated with psychological distress and job stressors, and positively associated with problem-solving coping. Furthermore, the direct association between social skills and psychological distress was stronger than the association between social support and psychological distress. These findings suggested that improving not only social support at work but also individual social skills is important for nurses' mental health.     

不同气质类型护生的综合操作考试成绩比较

目的探讨综合操作考试应激情况下不同个性特征和气质类型护生的心理素质,采取各种心理干预和训练的手段,使各方面能力得到更好地发挥。方法采用艾森克个性量表（EPQ）和7500无创血压脉搏氧饱和度监护仪对参加毕业实习前综合操作考试的384名护生进行调查分析。结果多血质和黏液质的护生综合操作考试的成绩优于胆汁质和抑郁质的护生（H=39．4,P〈0．005）;操作考试前后脉率差〈30次／min者,优秀的成绩比例大;而≥30次／min者,成绩不够理想。结论在操作考试应激情况下,个性特征稳定的外向型（多血质）和内向性（黏液质）的护生更能应对应激环境的变化,个性特征不稳定的外向型（胆汁质）和内向性（抑郁质）的护生抗应激能力差,易致心理紧张和焦虑。     

A longitudinal study of children's voices in regard to stress and coping during the transition to school

This study explores (1) how parental and teacher scaffolding and children's coping strategies contribute to children's adjustment during the transition from preschool to school; and (2) how children's perception of stress and coping are constructed over time. The sample included 216 six-year-old children, their parents and teachers. The parents, teachers and children reported that many children encountered social stress and being incompetent at school, and most of the children used either direct problem-solving or seeking social support to cope with stress, but had not used emotion-focused coping strategies learnt at preschool. Compared with the parents’ and teachers’ responses, the children reported more incidences of social stress. Compared with the children's responses, more parents and teachers reported children being incompetent in learning or self-help skills at school. Implications of the study were discussed at the end of the article.     

Violencia de género en estudiantes de enfermería durante sus relaciones de noviazgo

AimTo determine the prevalence of gender violence (GV) suffered by student nurses and to identify its relationship with some sociodemographic and personal variables (social support and self-esteem) and their perception about their role as primary care providers.DesignCross-sectional study.LocationFaculty of Medicine and Health Sciences (University of Oviedo).ParticipantsNursing students.Main measurementsThe CUVINO questionnaire was used. It measures 42 behavioral indicators and 8 GV factors and allows to identify technical and perceived violence during courtship and other related situations. The level of social self-esteem, support and variables related with the nursing role were also measured.ResultsUsing the standard of “zero tolerance”, 85.8% suffered technical violence, mainly by “detachment” and “coercion” (73.3%), while almost 1 in 5 also suffered “physical” violence (18.3%). A lower percentage (9.0%) reported having been really ill-treated, perception related to the global proportion of students who felt trapped (31.7%, P <.001), felt fear (13.8%, P <.001) and a further delay in breaking the relationship (13.2 months vs. 3.6; P <.05). Suffering technical violence was associated with less social support (P <.05) and less social self-esteem (P <.01). Academic training in GV improves recognition.ConclusionsThe prevalence of GV situations between student nurses is very high and recognition is poor. Academic training could improve the perception of the problem, thus it would be desirable to strengthen its inclusion in the university curriculum, together with specific skills training.     

Children with diabetes: perceptions of supports for self-management at school

Diabetes affects many children. Researchers know little about children's perceptions of what type of support they need at school, which was a focus of this study. Group interviews and surveys examined children's perceptions of support in caring for their diabetes (type I diabetes) from school nurses, teachers, and friends. Results indicated the children felt supported at school, but improved flexibility by teachers and nurses (e.g., let me keep my meter with me always) and individualized care plans may improve their ability to manage their diabetes at school. Participating in after-school activities may be difficult for middle school youth. Children reported they needed additional help and support to cope with hypoglycemic episodes.     

Variations in practice nursing: implications for family health services authorities

Differences between Family Health Services Authorities (FHSAs) in practice nurse activities are described and interpreted, using the results of postal questionnaires to all practice nurses in England and Wales in late 1992. There were an estimated 15000 practice nurses of whom 12589 (85%) returned a completed questionnaire, which asked about 30 tasks, including domiciliary visits, carried out by practice nurses; employment conditions, professional qualifications, experience, and clinical grading; and practice characteristics. The proportion of nurses undertaking four out of five tasks varied by a factor of two or more across FHSAs. Just over a third (39%) of the variation in nurses' activities could be explained by professional and practice characteristics. The analysis distinguished between FHSAs where nurses were more likely to engage in tasks requiring diagnostic and clinical skills, including assisting with minor surgery, and FHSAs where nurses were more likely to conduct domiciliary visits, help with chronic disease management, and provide advice on welfare benefits, incontinence and health promotion. The former FHSAs were characterized by larger practices with four or more partners employing several nurses, training practices, and practices with a manager. The latter group was characterized by smaller inner city or urban practices, including single-handed partnerships, and practices often employing one nurse. The 1990 general practitioner (GP) contract boosted nurses' involvement in those activities attracting new payments but its impact on their roles and responsibilities was mediated by their professional skills and experience and the type of practice where they worked. The contribution of practice nursing to the delivery of primary and community health care varies considerably. Further research is required to find out whether role diversity reflects uncertainty about the appropriate use of their skills. FHSAs need to develop a variety of strategies to support and promote practice nursing.     

A departmental stress management plan

To reduce stress, most people and organizations need to improve their skills in recognizing and coping with stressors. Department plans like the one described provide a good method of understanding and learning to cope with specific stressors. Researchers analyzed the effects of a stress management plan for registered nurses in an acute care hospital. This plan, called stress inoculation, began with education on stress and coping skills. The nurses were then exposed to the real-life stressors and expected to use the newly learned coping skills. Later, the nurses were asked to evaluate the effectiveness of the coping skills. The results of the study showed that the nurses' stress was reduced through stress management and that coping skills were the key ingredient. Education was needed to teach the coping skills, but by itself, education showed no benefit. If supervisors and employees remain committed to the departmental stress management plan throughout the six phases, the likelihood of reducing stress, improving morale, and increasing productivity is high.     

Affective and cognitive antecedents to eating episodes in bulimia and binge eating

The present study investigated seven antecedents to the binge-purge cycle proposed by Orleans and Barnett (1984), including restraint, stress, mood, thoughts of food, fatigue, hunger, and dichotomous cognitions. For 1 week, 19 bulimics, 15 binge eaters, and 20 normal control subjects recorded detailed information about these antecedent conditions and the types and quantities of food consumed for each eating episode. Results indicated that prior to their binge episodes, bulimics reported significantly greater stress, preoccupation with food, and negative mood than binge eaters reported prior to their binges and normal controls reported prior to all of their eating episodes. Both bulimics and binge eaters reported greater dichotomous cognitions prior to binge episodes than normal controls experienced prior to all of their eating episodes. Comparisons of the antecedents to eating episodes which bulimics and binge eaters regarded as nonbinge episodes with all eating episodes of the control group indicated that although bulimics and binge eaters experienced significantly greater negative moods than normal controls prior to their nonbinge episodes, only bulimics experienced significantly greater dichotomous cognitions prior to these eating episodes. Theoretical and clinical implications of these findings are discussed.     

Weight Measurements in School: Setting and Student Comfort

ObjectiveTo examine how body mass index assessments are conducted in schools and whether student comfort with assessments varies by students’ perceived weight status, weight satisfaction, or privacy during measurements.MethodsIn-person cross-sectional surveys with diverse fourth- to eighth-grade students (n = 11,510) in 54 California schools in 2014–2015 about their experience being weighed in the prior school year.ResultsHalf of the students (49%) reported being weighed by a physical education teacher and 28% by a school nurse. Students were more comfortable being weighed by nurses than physical education teachers (P = 0.01). Only 30% of students reported privacy during measurements. Students who were unhappy with their weight (P <0.001) and those who perceived themselves as overweight (P <0.001) were less comfortable being weighed than their peers.Conclusions and ImplicationsStudent weight dissatisfaction, higher perceived weight status, and being female were associated with discomfort with school-based weight measurements. Prioritizing school nurses to conduct weight measurements could mitigate student discomfort, and particular attention should be paid to students who are unhappy with their weight to avoid weight stigmatization.     

Randomized controlled trial of the effectiveness of an intervention to implement evidence-based patient decision support in a nursing call centre

We evaluated the effect of an intervention on call centre nurses' knowledge of decision support and skills in coaching callers facing value-sensitive health decisions. Forty-one registered nurses at a health call centre were randomly assigned to an intervention or control group. The intervention was a coaching protocol, online tutorial, skills building workshop and performance feedback. The main outcome measures were: knowledge test; blinded quality assessment of coaching skills during simulated calls and call duration. Compared with controls, nurses in the intervention group had better knowledge (74 versus 60%, P = 0.007) and decision coaching skills (81 versus 44%, P < 0.001), particularly in assessing decisional needs (information, values clarity, support, stage and timing of decision) and addressing support issues. Call duration did not differ (18.5 versus 16.7 min, P = 0.73). The coaching protocol was rated as compatible with nurses' views on decision-making and more advantageous compared with their usual practices. The intervention improved the quality of nurses' decision coaching without affecting call duration.     

Teaching the teachers — a needs assessment of tutors for a new clinical skills course

There is an increasing trend in undergraduate education towards teaching clinical skills from a community base. A new clinical curriculum was introduced in Newcastle upon Tyne in 1995, beginning with an integrated clinical skills course. Although the attitudes and views of general practitioners (GPs) towards community-based clinical teaching have previously been reported, their perceived training needs have not been formally identified. The aims of this study were to identify the competencies needed by GPs for community-based clinical skills teaching, to compare and contrast these needs with their hospital colleagues, and to use the results to develop a teaching programme for the clinical tutors involved in the new course. In order of priority, the GPs and hospital tutors expressed similar needs: small-group teaching skills, assessing student needs, giving effective feedback and assessment of student performance, with a preference for the teaching to be organized within local teaching units. Most GPs and hospital tutors (73 and 69%, respectively) requested a distance-learning pack to complement the teaching. General practitioners rated resources for improving their individual clinical skills more highly than their hospital colleagues: for example, videotapes demonstrating examination techniques. Forty-six per cent of GP tutors had received some formal training in teaching methods compared to 29% of hospital tutors. The implications of the results for developing a 'Teaching the Teachers' course for clinical tutors are discussed.     

Faculty Behavior and Other Key Factors in Student Adjustment to Medical School

Physicians today need a number of non-cognitive attributes and skills in order to be maximally effective. However, these attributes and skills, such as caring and respect for others, self-awareness, and communication skills, are not always addressed in medical education. Many would-be physicians find that medical school is a grueling experience characterized by chronic stress, the need to recognize one's strengths and limitations, and dissonance between their own values and beliefs and those of the school. The faculty and administrators at one medical school developed a special extra-curricular program to render their undergraduate program more humanistic in supporting student socialization and adjustment. The program featured intentionally structured,faculty-facilitated small groups of first-year students.This study used focus group interviews to explore student perceptions of the effectiveness of the Personal, Professional, and Leadership Development Program and thereby to gain insight into the phenomena that affect the development of medical students as future health care providers. Findings showed that students described social support and academic support from peers and faculty as contributing to their adjustment. The most compelling factor in student adjustment was faculty behavior and attitudes. Implications for adult learning and humanistic education practices are described.This revised version was published online in October 2005 with corrections to the Cover Date.     

Stress, burnout and job satisfaction in rural psychiatric nurses: a Victorian study

OBJECTIVE: To measure the level of stress, burnout and job satisfaction in rural psychiatric nurses in Victoria, Australia. METHOD: This present study presents the findings of a research study undertaken with rural psychiatric nurses (n = 136) in two rural mental health services in Victoria. The study designed to measure their level of stress, burnout and job satisfaction using the Maslach Burnout Inventory (MBI), the Nursing Stress Scale (NSS) and Job Satisfaction Scale (JSS). RESULTS: The findings indicated that a low number rural psychiatric nurses suffered from 'high' level of burnout and the majority of nurses reported 'low level' of emotional exhaustion and depersonalisation scores. On the personal accomplishment subscale, only 11% recorded a 'high' score and 87% recorded 'low' score. On the Nursing Stress Scale, the 'workload' was the highest perceived stressor followed by 'inadequate preparation'. CONCLUSIONS: Paradoxically, the majority of rural psychiatric nurses stated that they were satisfied with their job, particularly with current situation at work, aspects of support and the level of involvement in decision making.     

Pre‐registration house officer training: a role for nurses in the new Foundation Programme?

PURPOSE: To explore senior nurses' views of pre-registration house officer (PRHO) training, including the scope for their contribution to the new Foundation Programme. DESIGN: Data reported here are drawn from a larger, national project, which aimed to identify a curriculum for the PRHO year. The project was based in the Education Development Unit, Scottish Council for Postgraduate Medical and Dental Education (SCPMDE), Dundee. As part of the project, 40 semistructured interviews, each lasting about 1 hour, were held with senior nurses. Interviews were fully transcribed and coded in the qualitative software NVivo for further analysis. Codes were studied for emergent themes and categories. PARTICIPANTS: Senior nurses (10 from each of the 4 postgraduate regions of Scotland), from diverse specialties. RESULTS: Data suggest considerable cross- regional/specialty consistency. Key emergent themes concerned the process of training as much as the educational outcomes. The nurses focused on the development of outcomes such as communication and teamworking in addition to clinical and practical skills. They guided the PRHOs informally, but were concerned that their own extended roles were detracting from this. DISCUSSION: Nurses are gaining increasingly advanced professional, clinical and practical skills. Traditionally, experienced nurses guide and support PRHOs, at least informally. Data collected suggested there may be scope for capitalising on their expertise, including formalising aspects of their contribution to the proposed PRHO Foundation Programme. However, this is a potentially sensitive area and more interprofessional dialogue is needed.     

The evaluation of a burnout workshop for community nurses

This study evaluates the effects of a burnout workshop that was conducted for community nurses (N = 64). The workshop included relaxation training, didactic and cognitive stress management, interpersonal skills training, and the enhancement of a more realistic professional role. The nurses' symptom levels (i.e., emotional exhaustion, tedium, psychological strain, and somatic complaints decreased significantly. However no significant changes were observed in the attitudinal component of burnout: the nurses' negative attitudes toward their recipients (depersonalization) and toward their performance on the job (reduced personal accomplishment) did not decrease. In addition, personality (i.e., the nurses' level of reactivity) played a moderating role: low reactive nurses who, by definition, are rather resistant to stress benefited more from the workshop than did high reactive nurses who are less resistant to stress. Since no control group was included, the results of this study are tentative and should be confirmed by future research.     

Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients

Objectives  Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL.
Methods  Year 2 students were randomly allocated to one of two groups for skills training. Group 1 ( n  = 64) were tutored by volunteer Year 6 students, and Group 2 ( n  = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t -test. Qualitative data, obtained from Year 2 students ( n  = 125) by written questionnaire and Year 6 students ( n  = 11) and SPs ( n  = 3) by focus group interviews, were analysed for themes.
Results  Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval − 3.8 to 2.4). The PAL environment was perceived as 'comfortable' and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching.
Conclusions  With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad.     

护士职业紧张状况及其影响因素

目的　探讨护士职业紧张及其影响因素。方法　采用职业紧张量表 (OSI R)对某市三级、二级、一级医院护士 (护士组 ) 2 4 8例和工厂、机关、服务和商业职工 (对照组 ) 319例 ,共计 5 6 7例进行研究。结果　护士组应对资源 (131.2 6 6± 17.176 )及工作能力 (32 .5 81± 3.15 8)明显高于对照组(12 6 .931± 19.10 8、31.84 0± 4 .0 6 9) ,差异有显著性 (P <0 .0 5 )。护士职业的主要紧张源为任务不适(RI)、责任感 (R) ,与对照组的差异有显著性 (P <0 .0 1)。护士组人际关系紧张反应明显高于对照组 ,差异有显著性 (P <0 .0 1)。护士组的个体应对资源子项 (休闲、自我保健、社会支持 )均明显高于对照组 ,差异有显著性 (P <0 .0 5 )。紧张反应与职业任务呈明显正相关 (r =0 .5 12 ,P <0 .0 1) ,与应对资源呈明显负相关 (r=- 0 .4 75 ,P <0 .0 1)。紧张反应的主要影响因素有休闲、社会支持、理性处事、任务冲突、责任感、工作环境差。结论　对护士增强社会支持、改善工作条件 ,以降低护士的职业紧张程度 ,保护和促进工作能力是职业卫生领域面临的重要任务之一。     

Perceived stress during undergraduate medical training: a qualitative study

INTRODUCTION: Medical education is long and emotionally taxing. It can involve levels of stress that lead to disruptions in both physical and mental health. This qualitative study explores the views of Year 5 medical students on the causes of stress throughout their undergraduate medical training. METHOD: Semi-structured interviews were conducted with 21 final year medical students at the University of Birmingham between January and May 2001. RESULTS: Pressure of work, especially in terms of preparing for examinations and acquiring professional knowledge, skills and attitudes were reported as the most stressful aspects of medical training. Transition periods, particularly between school and medical school, preclinical and clinical training, and clinical training to approaching qualification were highlighted as particularly stressful. A perceived lack of support from the medical school authorities also appeared to add to student stress levels. DISCUSSION: Student stress may be alleviated by greater guidance and support from the medical school during crucial transition periods. Aspects of professional socialisation may also need to be addressed to reduce the levels of stress associated with undergraduate training for future generations of medical students.     

国外工作的中国护士与工作有关紧张的研究

目的 评价在国外工作的中国护士与工作有关紧张及其与工作满意程度（JS）、社会支持（SS）的关系。方法 采用调查表的方法对在国外工作的111名中国护士进行了调查，并与124名国外护士的调查结果进行比较。结果 在国外工作的中国护士其紧张程度（SAS）较国外护士高，差异有显著性（P＜0．05）。几乎所有在国外工作的紧张因子（除工作负担外）均与SAS存在显著的正相关关系（P均＜0．01）。JS及SS与SAS存在着负相关关系（r＝0－0．472和r＝－0．232，P＜0．05）。SS与JS之间存在着正相关关系（r＝－0．212，P＜0．05）。结论 本次调查结果支持护士职业的性质是紧张的这一结论。在国外工作的中国护士较国外护士更为紧张。所有的紧张因子均和与工作有关紧张及对工作不满意有关系；社会支持在是紧张因子和与工作有关紧张的关系中起重要作用。