Resilience and mental health nursing: An integrative review of international literature

Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses’ resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person–environment process. Resilience was most often reported as low‐moderate, with positive correlations with hardiness, self‐esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses’ coping self‐efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience‐building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.     

Resilience of nurses at the epicenter of the COVID-19 pandemic in Lebanon

ObjectiveThe study aimed to investigate the level and factors associated with the resilience of nurses practicing at the main COVID-19 referral center in Lebanon.MethodsThe study utilized a cross-sectional survey design. Data were collected electronically in the spring of 2020 from 265 nurses. The questionnaire included five sections: demographic characteristics, job satisfaction, turnover intentions, exposure to violence, and resilience levels. Multiple linear regression was used to determine factors associated with resilience.ResultsResults showed that the overall score of resilience among nurses was 66.91 ± 13.34. Most nurses were satisfied with their job (67.8%), and most nurses reported that it is unlikely for them to quit their present work in the coming year (76.2%). Over the last year, three-quarters of nurses (74.7%) reported being ever exposed to a form of occupational violence. The resilience of nurses was directly associated with job satisfaction and male gender and inversely associated with intention-to-quit and exposure to violence (P < 0.05).ConclusionsEnhancing the resilience of nurses at the frontline of the COVID-19 pandemic improves their job satisfaction and retention and would help support the effectiveness and efficiency of care services. Nurse managers can regularly investigate the resilience of nurses and offer interventions that would strengthen it, especially at times of crisis.     

精神科护士良心压力与职业倦怠感的相关性研究

目的了解精神科护士良心压力与职业倦怠感现状,并探讨两者的相关性。方法采用便利抽样法对207名精神科护士应用一般资料调查表、良心压力调查问卷及Maslach职业倦怠量表进行调查。结果精神科护士良心压力整体处于中等水平,总分为(40.46±29.26)分,职业倦怠感为中重度水平;各维度得分由高到低依次为个人成就感低、情绪耗竭、去人性化,良心压力与职业倦怠感之间呈正相关(P<0.05)。结论精神科护士良心压力与职业倦怠感关系密切。提示护理管理者应重视精神科护士的心理状况,降低护士的良心压力水平,从而降低其职业倦怠感。     

Workplace aggression,psychological distress,and job satisfaction among Palestinian nurses: A cross-sectional study

BackgroundNurses can be exposed to aggressive behavior from patients, patient's relatives, colleagues and visitors.PurposeTo determine the prevalence of workplace aggression among Palestinian nurses in the Hebron district and to examine cross-sectional associations between exposure to workplace aggression and the occurrence of psychological distress and job satisfaction.MethodsOf 372 nurses eligible for the study, 343 were included (response rate of 92.2%). The sample comprised 62% females and 38% males. The participants responded to questions about their socio-demographic status, workplace aggression (WHO questionnaires), psychological distress (General Health Questionnaire, GHQ-30), and job satisfaction (Generic Job Satisfaction Scale).ResultsNinety-three (27.1%) of the respondents reported exposure to workplace aggression of any kind. Seventeen (5%) reported exposure to physical aggression, 83 (24.2%) reported exposure to verbal aggression, and 25 (7.3%) reported exposure to bullying. The patients and the patients' relatives were the main sources of physical and verbal aggression, whereas colleagues were the main source of bullying. Males reported a higher prevalence of bullying than females. Younger nurses reported a higher prevalence of exposure to physical aggression, verbal aggression and bullying. Verbal aggression was associated with more psychological distress. Bullying was associated with lower job satisfaction.ConclusionsMore than a quarter of the nurses reported that they had been subject to some sort of aggression at the workplace. Verbal aggression was associated with higher psychological distress. Workplace bullying was associated with lower job satisfaction. Increased awareness and preventive measures to address this problem among health care workers are warranted.     

An observational study of associations between nurse behaviour and violence in psychiatric hospitals

A cyclical model of violence to psychiatric nurses is proposed in this paper and a partial test of the model is reported. The model suggests that stress induced by exposure to violence leads to impaired staff performance and adoption of behaviours which make the re-occurrence of violence more likely. We tested the proposal that certain staff behaviours (e.g. expressing verbal hostility) are associated with an increased risk of assault by observing nurse–patient interaction on 12 psychiatric wards ( n =103 nurses). The verbal and physical interaction of (1) assaulted staff, (2) staff on violent wards, and (3) staff in grades which experience high levels of assault, were compared with those of respective low risk groups. There was some evidence of an association between interaction patterns and violence. We conclude this paper by discussing the implications of the model for psychiatric nursing practice.     

Health and safety of older nurses

The nursing workforce is aging at an unprecedented rate yet little is known about the health and safety of older registered nurses (RNs). The survey reported here examined the relationships between demographic variables, job attributes (job satisfaction, control over practice, and job demands) and the physical and mental health and job-related injuries and health disorders of 308 nurses over the age of 50. Findings indicate that nurses with higher job satisfaction, higher control over practice, and lower job demands experienced increased physical health. Increasing age was positively correlated with mental health. Almost a quarter of older RNs experienced a job-related injury within the past 5 years, and over a third experienced job-related health problems. Nurses with higher job demands and those employed in hospital settings were more likely to have an injury. Overall, older RNs reported higher levels of physical and mental health than the national norm. Efforts must be made to keep older RNs healthy so we can retain them in the workforce.     

Mental health nurses’ emotions,exposure to patient aggression,attitudes to and use of coercive measures: Cross sectional questionnaire survey

BackgroundMental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses’ exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence.ObjectivesTo identify relationships between mental health nurses’ exposure to patient aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint.DesignCross-sectional, correlational, observational study.SettingsLow and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England.ParticipantsN = Sixty eight mental health nurses who were designated keyworkers for patients enrolled into a related study.MethodsParticipants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses.ResultsNurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression was unrelated to nurses’ emotions. Nurses’ reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/non-involvement in coercive measures.ConclusionsVerbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be ‘at risk’. Future research priorities are considered.     

Psychosocial precursors and physical consequences of workplace violence towards nurses: A longitudinal examination with naturally occurring groups in hospital settings

BackgroundWorkplace violence towards nurses is prevalent and consequential, contributing to nurses’ reduced health and safety, worsened job attitudes, and compromised productivity.ObjectivesTo examine if organizational violence prevention climate as perceived by nurses predicts nurses’ physical violence exposure and if physical violence exposure predicts nurses’ somatic symptoms and musculoskeletal disorder symptoms.DesignA two-wave longitudinal design with naturally occurring groups, with a 6-month interval.MethodsAnalysis of covariance and logistic regression were applied to test the proposed hypotheses among 176 nurses from two hospitals in the U.S. who participated in both surveys required by this study. All nurses from the two hospitals were recruited to participate voluntarily. The response rate was 30% for the first survey and 36% for the follow-up survey. Among the subjects, only 8 were male. On average, the subjects were about 45 years old, had a job tenure of about 17 years, and worked approximately 37 h per week.ResultsViolence prevention climate, specifically the dimension of perceived pressure against violence prevention, predicted nurses’ chance of being exposed to physical violence over six months (odds ratio 1.69), with no evidence found that violence exposure affected change in climate reports. In addition, results supported that nurses’ physical violence exposure had effects on somatic symptoms, and upper body, lower extremity, and low back pain over six months.ConclusionsFindings of this study suggest that reducing organizational pressure against violence prevention will help decrease the chance of nurses’ physical violence exposure and benefit their health and safety.     

A comparative study of the experiences of violence of English and Swedish mental health nurses

Recent studies suggest that violence in health care environments, especially mental health care, appears to be increasing. Although there is a lack of cross-cultural studies to prove it, this increase in violence would seem to be an international phenomenon. The present study sought to compare the extent and nature of violence encountered by mental health nurses in Sweden and England. Systematic studies of violence have previously been carried out independently in both countries but this was the first attempt to compare levels of violence. Clearly defined study protocols were put in place, an operational definition of 'violence' adhered to, and random samples recruited. A specially designed questionnaire was sent to every subject (Swedish nurses n=720; English nurses n=296) enquiring about the extent of nurses' exposure to violence, the nature and severity of the violence experienced, and the effect of violence on self-esteem and job satisfaction. Significant differences were found with English nurses experiencing more violence than their Swedish counterparts. Yet support for English nurses appeared to be less good than for Swedish nurses. Reasons for the differences are discussed along with possible measures to minimise the frequency of violence against nurses and the negative effects on their work.     

Violence Against Nurses in the Triage Area: A Mixed-Methods Study

IntroductionWorkplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses.MethodsA mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups.ResultsNinety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups.DiscussionNurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.     

Differences in job stress experienced by female and male Japanese psychiatric nurses

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job‐related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health‐care interventions for psychiatric nurses.     

Work related stress,burnout, job satisfaction and general health of nurses: A follow‐up study

Nurses experience high levels of work related stress and burnout as well as low job satisfaction and poor general health owing to the nature of their work. This paper seeks to provide a better understanding of the nature of relationships between work related stress, burnout, job satisfaction and general health of nurses over one year. This study involved a longitudinal design. Two hundred and seventy seven nurses from four hospitals completed a follow up survey consisting of five questionnaires. Data were collected between 2013 and 2014. The data were analysed using generalized estimation equation analysis. Lack of support was associated with burnout, patient care was associated with job satisfaction and staff issues were associated with general health of nurses. Burnout is more strongly related to job satisfaction than general health. The findings of this study could inform evidence based policy and practice through interventions aimed at improving job satisfaction and reducing the impact of burnout on general health of nurses.     

Job satisfaction and resilience in psychiatric nurses: A study at the Institute of Mental Health,Singapore

Job satisfaction ranks highly as one of the main factors influencing turnover rates among nurses. Mental health nursing has been reported to be a particularly stressful specialty, yet little is known about the level of job satisfaction among psychiatric nurses in Singapore. Resilience is defined as a means of adapting to stress at the workplace, and could serve as a factor influencing job satisfaction. The present study aimed to explore the current level of job satisfaction among psychiatric nurses working in the only tertiary psychiatric institution in Singapore, the influencing factors, and the relationship between resilience and job satisfaction. A survey questionnaire consisting of the following was administered to all eligible nurses working in the Institute of Mental Health between the period of 16–24 December 2014: (i) The McCloskey and Mueller Satisfaction Scale; (ii) The Resilience Scale; and (iii) sociodemographic data form. A total of 874 nurses were eligible for participation in the study, and a total of 748 nurses responded, totalling 85.6% response. A mean satisfaction score of 95.21 and mean resilience score of 125.74 were obtained. Mean satisfaction and resilience scores were the highest for nurses with longer working experience and those of older age. A positive and significant association between satisfaction and resilience scores (P = 0.001) was obtained. Psychiatric nurses in Singapore are generally satisfied with their job, but this can be further improved with the strengthening of personal resilience.     

The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses.

Nursing is known to be stressful. Stress detrimentally can influence job satisfaction, psychological well-being, and physical health. There is a need for increased understanding of the stress that nurses experience and how best to manage it. Three hundred twenty Australian acute care public hospital nurses participated in a study by completing four questionnaires that examined (a) how various workplace stressors relate to ways of coping, demographic characteristics, and physical and mental health and (b) which workplace stressors, coping mechanisms, and demographic characteristics were the best predictors of physical and mental health. Significant correlations were found between stressors and physical and mental health. Multiple regression showed age to be the only significant predictor of physical health. The best coping predictors of mental health were escape-avoidance, distancing, and self-control. Other significant predictors of mental health were support in the workplace, the number of years worked in the unit, and workload. Mental health scores were higher for nurses working more years in the unit and for those who used distancing as a way of coping. Mental health scores were lower for nurses who used escape-avoidance, lacked workplace support, had high workload, and used self-control coping. The findings have implications for organizational management, particularly in terms of recommendations for stress management, social support, and workload reduction.     

CLINICAL SUPERVISION,BURNOUT, AND JOB SATISFACTION AMONG MENTAL HEALTH AND PSYCHIATRIC NURSES IN FINLAND

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

Clinical supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

Stress amongst district nurses: a preliminary investigation

This paper presents the results of a pilot study investigating stress among district nurses in the north-west of England. Nurses completed questionnaires covering job satisfaction, mental health, stress, Type A behaviour, health behavior, coping skills and demographic details. A specific measure of stress was developed following in-depth interviews with primary care professionals, including district nurses. A total of 79 district nurses took part in the study. The major sources of stress isolated by the district nurses related to: time pressure, administrative responsibility, having too much to do, factors not under their control, interruptions, keeping up with National Health Service (NHS) changes, and lack of resources. Factor analysis of stress questionnaire responses identified five major factors: demands of the job and lack of communication, working environment, problems with patients, work/home interface and social life, and career development. The highest levels of satisfaction were reported for the amount of variety in their job and the lowest level of job satisfaction was reported for chance of promotion. The results revealed that the mental wellbeing of the nurses was higher than that of the other population groups. Furthermore, multivariate analysis revealed three major stressors that were predictive of high levels of job dissatisfaction: demands of the job and lack of communication, working environment, and career development. The implications of the findings for further research are considered.