Systematic Review of Stress Management in Nursing Care Settings

This report provides a comprehensive systematic review of stress management techniques for nurses, focusing on interventions to reduce burnout in healthcare settings, particularly those involving the care of severely ill elderly patients. The study examines various strategies, including the use of the PICO process, literature searches using databases like Medline, Em-base, and Psyc-Net, and the application of inclusion and exclusion criteria. The review assesses the quality of the included studies, considering factors like risk bias and the effectiveness of different intervention approaches (person-directed, work-directed, and combined strategies). The report highlights the importance of addressing stress in nursing, discusses the limitations of current research, and suggests directions for future studies to determine the most effective methods for supporting nurses' well-being and reducing job-related stress, ultimately aiming to improve patient care and reduce absenteeism.

MANAGING NURSING CARE
ABOUT STRESS MANAGEMENT

Table of Contents
INTRODUCTION...........................................................................................................................1
REVIEW QUESTION.....................................................................................................................1
LITERATURE SEARCH................................................................................................................2
QUALITY OF THE REVIEW........................................................................................................3
RESULT..........................................................................................................................................5
DISCUSSION..................................................................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
Stress in an organisation is the most serious issue in the occupation of nursing.
Absenteeism at workplace is often seen due to burnout. Strain in relation to career and profession
can be described when an individual can't cope up with demand placed and is surrounded by
continual strain at workplace. These responses are explained by nurses as feeling of emotional
tiredness, a weird attitude towards profession and with other people, or low growth in personal
life. Nurses revealed that the reason behind the stress is due to continuous challenges they face in
their job or occupation (Peters & et.al., (2012). These consequences faced by health-care
professionals often lead to bitterness, aggressiveness, depression, low self-esteem, sleep
deceptiveness etc. They may also suffer from feeling of guilt, shame or fear of failure due to
stress at job.
Background of the study
Signs and symptoms of burnout may include fatigue, nausea, mood swings, inability to
concentrate, biting of nails, anxiety, depression, fatigue, feeling of sadness etc. Most of the time
it has also been analysed that health-care professionals who are facing stress at job also have
ongoing grief. It means, they continuously think about suicide. Various employment assistance
program has been implemented in order to reduce burnout of nurses. Many techniques are also
established like relaxation method which includes slow breathe, muscle relaxation techniques,
which must be practised by every health-care provider (Healy & Tyrrell, 2011). For cutting down
the stress nurses can also follow some task at individual like, they can share their feelings with
family or friends, follow healthy diet, having fun with relatives, setting realistic objectives. All
these methods may support them in cutting down burnout while treating inpatient elderly people.
Burnout in health-care professionals is related with frequent absent-ism from job, low
satisfaction in work, and a raised purpose of leaving the occupation. Many tools are developed
by researchers in order to reduce tension of nurses. Assignment will include methods of
assessing risk and keen analysis on techniques implemented in order to cure tenseness. It will
also consist of exclusion and inclusion criteria of study and various search strategies or
techniques used by author for effective completion of assignment.
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REVIEW QUESTION
The report which has been studied is a systematic review about how health-care professionals
can manage the strain raising in their lives. The author has clearly explained that their aim is to
interpret and evaluate research about stress interventions for nursing staff in the care of severely
ill old aged patient or individual having genetic disorder. They have critically analysed studies
that were published to explain the influence of certain interventions on stress of nurses (Epp,
2012). Specific and particular questions were clearly moved around finding studies which proved
the effect of nursing interventions in terms of reducing stress. They have also made
recommendations for the future research. Study was particularly based on reducing job related
stress of health-care professionals.
The population which were taken in study was nursing personnel that consists of certified
and college graduated nurses, licensed health-care professionals, carers and service user care
attendants (Boyle, 2011). PICO process was used in order to develop good clinical research for
reviewing intercession used in reducing burnout of specialist. The four components of this model
are problem, intervention, comparison and outcome. Research shows the issues that are faced by
nurses while treating patients can result into burnout. Stress in health-care professionals may be
caused due to their physical and emotional need or feeling of disempowerment. PICO will help
the health-care professionals in better understanding the factors which are contributing for
increasing stress among nurses.
As Ward (2011) stated that nursing is a complex profession and requires a lot of hard
work and attention by providers which create a huge tension for them. Intervention consists of
strategies which are used in order to reduce the stress in lives of an individual. Methods can
include introducing health-care professionals with programs such as meditations, involvement in
physical activities like yoga, dance, aerobic, providing certain therapies to reduce stress.
Outcomes that could be seen after study and implementing of these strategies is cut down of
tension in nurses’ life
LITERATURE SEARCH
Various Strategies were found out in the assignment by using various keywords like
“nurses’ burnout”, “stress management”, “systematic review” and “PICO”. Search terms was
also related to research question and terms like stress in nurses, strategies, methods etc. Usage of
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appropriate database like medline, Em-base, Medline and Psyc-Net was taken in the study.
Many articles and journals were also searched which was published between year 2011- 2017
and English language was chosen in order to cut short the search option. Prism flow chart was
also one of the basis for literature search. It is the graphical representation of the data which is
used in the systematic review. (Reeve & et.al. (2013). Review design has been considered as the
basis of the study. Many studies were also excluded like studies developed before year 2011,
burnout in patients, stress reducing strategies for service users were not at all considered. Study
is only based on the authentic articles and no duplicate work was being considered. This chart
can help in better and effective understanding of the factors.
Various methods were also used to assess risk of preconception. It can be termed as
errors or deviation from truth in outcomes (Pulido‐Martos, Augusto‐Landa & Lopez‐Zafra
(2012). For evaluating the risk bias help from various clinical researchers was taken which may
consists of selection, performance, attrition, reporting oblique. Many other factors were also
analysed like controlling of elements which lay emphasis on interventions, measuring
characteristics of groups, implementing the effect of intervention on data collection, laying
emphasis on incomplete information and reporting of outcomes. These methods of clinical risk
bias have supported in timely completion of the assignment.
QUALITY OF THE REVIEW
All the studies included in the review has met the inclusive criteria which were set by the
appraisers themselves. The characteristics of included and excluded criteria consists of many
journals in different languages like French, Spanish, German, Chinese, English were also
reviewed in order to find better results. Various keywords were also used in search strategies like
occupation, health-care professionals, burnout, employment, nursing, severely ill patients. The
study was conducted on lot of professional as well as college nurses (Por & et.al. (2011). All the
questions related to work resulted in stress . No appraisal checklist has been approved in the
study. There were also more studies conducted which includes social workers, dietician,
physicians, etc. The exclusion criteria for the research included articles which were not published
in English language, study that has only focused on stress of patients, the impact of occupational
burnout on service user etc. These were excluded in order to make study more specific and
effective.
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Authors have also considered a flow chart which reveals about how the articles were
selected and approved. A total of 500 journals and articles were searched and found out with the
help of database. Only 248 studies has met the inclusion criteria, from which a final of 15 articles
were only selected for further study. Other journals were rejected as they were not particularly
based on stress, not including inpatient elderly care, no involvement of interventions, absence of
nurses (McCorkle & et.al. (2011). Finally, a total of only 15 studies were considered which
matches both exclusion and inclusion criteria and was selected for systematic review. Also, these
journals were analysed and evaluated by other 3 reviewers. A systematic research was
established in the databases Em-base, Medline and Psyc-Net published year 2011 to 2017.
For data synthesis, a table was prepared by authors which shows the comparison between
outcomes. This helped interpreters to critically examine articles which were selected
individually and supported them in understanding similarities and differences between
outcomes or results. It was done because there were different intervention ideas and they were
collected on the basis of their approaches. Intercession effects has been taken in relation to stress
of nurses (Gates, Gillespie & Succop (2011).
Moreover, effects were categorized on the basis of period such as short or long term. In
the article “burnout intervention studies for inpatient elderly care”, participation were grouped on
the basis of work-person directed, and combine strategies and also in the other study “ care of
elderly” same basis was taken for measuring the effect of interventions. It came out that person
directed approach was able to reduce stress in nurses for a short period (approximately one
month) however combine and work directed approach helped in reducing burnout for a long
term. Furthermore, it was found out that only 3 articles show that the interventions have a
positive effect on stress of staff. These methods have helped in promoting health and well-being
among nurses and also supported them in reducing burnout in their occupation or job. A general
reduction was observed on nurses stress scale by implementing these models.
Neville & Cole (2013) explained a comprehensive review study which makes use of
synthesised current evidences for measuring the effect of person directed care model on resident
outcomes. Searches were conducted using only English language with the help of multiple
database. In addition, a reference list search was also made in relation to relevant articles.
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Illustration: Exclusion and inclusion criteria
Source: Burnout intervention studies for inpatient elderly care nursing staff:
systematic literature review. (2017).
§
RESULT
The assignment was a systematic review of the chosen topic and helped the researchers in
understanding the gap in the study, developing knowledge base on burnout of nursing staff, and
creating future study directions. As stated by Hegney & et.al. (2014) there review of literature
was a descriptive study and interrupted by publication bias which means that articles or journals
are only published when only it considers positive outcome. The study was influenced because
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of it; as only English language was considered for the search strategy. This was because of
approaches which were considered was heterogeneous, some studies lack information, or the
paper used was unable to compare the effects of estimates. It was analysed that there were only
few interventions which bring out positive effects for reducing burnout in nursing staff.
Author also explained that the work directed and combine approach has long termed
effect than person centred method. However, the evidences are limited and specific. Moreover,
it is suggested to collect more evidence or established further research in order to find the best
intercession for reducing burnout in health-care professionals while treating inpatient elderly
aged people. Although the outcomes can be applicable to general population, a more thorough
research between stress and other elements like client results and workforce occupational
competencies are required. It was also very difficult draw outcomes because of the heterogeneity
of the research and methodological weakness.
It was also revealed that person centred care has helped in meeting individual needs and
demands by supporting the participants emotionally but was generally for short period. This
model was designed to meet nurses’ ability to manage burnout at individual level. Combine and
work directed approaches in which strategies like encouraging nurses to participate in physical
exercise such as dance, yoga and aerobics. These models were created in order to meet health-
care professional abilities at organisational level (Westermann & et.al. (2014). The activities
have a long term effect on health-care professionals. It has been noticed that these tasks improve
their well-being and reduce stress in them. The strategies also focused on providing secure and
safe environment to nurses. This has also improved their productivity and efficiency in work,
removed absent-ism, and reduce occupational stress for treating inpatient elderly people.
DISCUSSION
A total of 15 articles were considered and chosen. The main area of investigation was
reducing burnout of health-care professionals at workplace or while curing inpatient elderly
individuals. The result was totally applicable to population studied that included registered or
licensed nurses, both college graduation and professional carers.
For systematic review of the study, various methods like person- work directed, and
combined approach has also been implemented on participants that shows results as some
techniques have short term effects while others have impact on nurses for long run. After
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reviewing multiple articles only, few has shown positive outcomes on the study. However,
evidences are limited.
The systematic review has kept the focus on all important outcomes. Like it was noticed
by the authors after involving in activities like meditations, happy living therapy, getting
emotional support, nurses have been more relaxed and stress free. It also had reduced absent-ism
from workplace. Furthermore, results also revealed that health-care professionals are not
undergoing and these therapies are surrounded with more stress and tension. Outcomes also
explained that the task had made nurses more productive and effective in their work (Villani &
et.al. (2013). Treatment quality has also been improved after in-taking these activities or
therapies.
The systematic review has supported author in knowing about the cause of stress in
nurses. It may be because of long shifting hours, less pay, inability to cope up with expectations
or demands (Van Dusseldorp & et.al (2011). This has also helped in understanding the
similarities and differences between various interventions. The review implemented was less
costly and also took minimum time in providing results. The study was merely descriptive,
heterogeneous and some researches also lacked information and the paper which has been used
was unable to compare the effect estimates. Researchers has only made use of published and
authentic data which has made the study more effective.
Person-work directed and combine approaches have been used in the research. The work
centred assessment has longer impact on the participants or nursing staff. It is therefore
recommended for future search that more evidence should be collected and conduct further
research in order to find out the best interventions for cutting down the burnout in health-care
providers (Burnout intervention studies for inpatient elderly care nursing staff: systematic
literature review, 2017). There is also a need for more thorough study on elements like clients
results and professional competencies of staff. Researchers such as longitudinal data base along
with representative samples, longer study, and period of investigation can help in increasing the
quality of research.
CONCLUSION
This is to summarised that the chosen systematic review on managing nursing care about
stress management can be used as evidence to give references in relation to implementing
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interventions which can be required to reduce nurses staff specially while dealing with inpatient
elderly aged people. Further, it included methods like person-work centred, combine approach
which helps in cutting down burnout in nursing staff. Work directed technique has longer impact
on health-care professionals in comparison to person centred care. This approach has improved
the quality of work and reduced absent-ism from their profession. They have also helped in
enhancing the health and well-being of nurses.
Assignment also consists of databases on basis of w study was made. A systematic
research was established in the databases Em-base, Medline and Psyc-Net published from year
2011 to 2017. It also consisted of search strategies such as usage of keywords such as
occupation, burnout, stress, elderly inpatient etc. Further it includes inclusion and exclusion
criteria. Articles published in English language was only considered. Search results which
focused on stress in patients, strategies reducing burnout in service users were excluded. Also,
articles published before year 2011 were not considered in the study. Assignment also consisted
of signs and symptoms like fatigue, insomnia, mood swings that can be seen in nurses because of
occupational stress.
Study also involved results which were obtained after implementing interventions. It was
analysed that nurses opted for stress reducing therapies like meditation were more relaxed than
those who have not performed these activities. Further, assignment also concluded few
recommendations such as thorough study on elements like clients results and professional
competencies of staff.
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stress and productivity. Nurs Econ. 29(2).59-66.
Healy, S. & Tyrrell, M. (2011). Stress in emergency departments: experiences of nurses and
doctors. Emergency nurse.19(4).
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Hegney, D. G. & et.al., (2014). Compassion satisfaction, compassion fatigue, anxiety, depression
and stress in registered nurses in A ustralia: study 1 results. Journal of Nursing
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McCorkle, R. & et.al., (2011). Self‐management: Enabling and empowering patients living with
cancer as a chronic illness. CA: a cancer journal for clinicians.61(1). 50-62.
Neville, K., & Cole, D. A. (2013). The relationships among health promotion behaviors,
compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a
community medical center. Journal of Nursing Administration.43(6).348-354.
Peters, L. & et.al., (2012). Is work stress in palliative care nurses a cause for concern? A
literature review. International Journal of Palliative Nursing.18(11).561-567.
Por, J. & et.al.,(2011). Emotional intelligence: Its relationship to stress, coping, well-being and
professional performance in nursing students. Nurse education today.31(8). 855-860.
Pulido‐Martos, M., Augusto‐Landa, J. M., & Lopez‐Zafra, E. (2012). Sources of stress in
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Reeve, K. L. & et.al., (2013). Perceived stress and social support in undergraduate nursing
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Van Dusseldorp & et.al., (2011). Emotional intelligence of mental health nurses. Journal of
Clinical Nursing.20(3‐4).555-562.
Villani, D. & et.al., (2013). Self-help stress management training through mobile phones: An
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Ward, L. (2011). Mental health nursing and stress: Maintaining balance. International Journal of
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Westermann, C. & et.al.,(2014). Burnout intervention studies for inpatient elderly care nursing
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Online
Burnout intervention studies for inpatient elderly care nursing staff: systematic literature
review. (2017). ONLINE] Available through:
<https://www.ncbi.nlm.nih.gov/pubmed/12148838>
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