Critical Evaluation: Factors Causing Work Stress in Psychiatric Nurses

This report provides a critical evaluation of the factors causing work stress levels in psychiatric nurses in Australia. It begins by outlining the background and introduction to psychiatric nursing as a stressful occupation, identifying stressors such as poor working relationships, burnout, demanding patient interactions, understaffing, and low job satisfaction. The study aims to determine the causes of stress among psychiatric nurses with over two years of experience, compare stress levels between mental health and general nurses, and critically evaluate the factors contributing to stress. The scope of the research uses the PICO tool to address clinical scenarios and suggests interventions like rotational working, compensation, limited working hours, and stress management programs. The literature review defines job stress and highlights conflicts with co-workers, lack of support, and low self-esteem as potential causes. The research employs a qualitative method, reviewing relevant literature from databases like CINAHL, ProQuest, and MEDLINE, focusing on studies beyond 2010. The study acknowledges limitations such as qualitative data constraints and sample size dependency. The conclusion emphasizes that decreased job satisfaction, low self-esteem, lack of support, and patient-related problems contribute to stress, recommending compensation, rotational shifts, and stress-buster programs for psychiatric nurses.

RESEARCH PORTFOLIO
A CRITICAL EVALUATION OF FACTORS
CAUSING WORK STRESS LEVELS IN
PSYCHIATRIC NURSES
2018

Table of Contents
GENERATION OF A RESEARCH.........................................................................................................2
BACKGROUND..............................................................................................................................2
INTRODUCTION............................................................................................................................3
OBJECTIVE OF STUDY...................................................................................................................4
SCOPE OF STUDY..........................................................................................................................5
LITERATURE REVIEW....................................................................................................................6
METHOD OF REVIEW...................................................................................................................7
RESEARCH DESIGN.......................................................................................................................8
LIMITATIONS................................................................................................................................9
TIME SCHEDULE.........................................................................................................................10
CONCLUSION.............................................................................................................................11
LITERATURE CRITIQUE...................................................................................................................12
REFERENCES...................................................................................................................................17
Student ID Page 1

GENERATION OF A RESEARCH
BACKGROUND
Psychiatric nursing or mental health nursing is an integral part of nursing practice. Studies have
shown that nurses are under considerable job stress which can lead to the mental health
disorders and failure in duties (De Looff, et al. 2014). The research is focused on a critical
evaluation of factors causing work stress levels in psychiatric nurses. It is considered as one of
the management issues which portrays the interaction level with psychiatric nurses. The
general working structure of the psychiatric nurses is way too different from other department
nurses.
The working profile of psychiatric nurses covers the intervention strategy, regular interaction
level with patients, and rehabilitation of the patients which faces chronic and complicated
mental health problems. Some of the mental health problems that are faced by nurses are
schizophrenia, dementia, and schizoaffective disorder, psychosis, anxiety, and depression.
Nurses in these areas receive special training in handling the patients but it results in generating
the stress level in them. Some of the identified reasons for the cause of the increase in work
stress level are- Work stress and Burnout among nurse, Comparative less job satisfaction, the
likelihood of job injury, disorientation in thinking. Stressors of nursing have been identified in
the study. However, focusing on the factors of causing stress in the psychiatric nurses has been
investigated (Johnson, et al.2017). The current perception of the work stress level and its
influencing factors are aimed to understand the nurse’s experiences and evaluation of the
factors causing the stress level.
Student ID Page 2

INTRODUCTION
Psychiatric Nursing is considered as a stressful occupation. It has been identified number of
stressors depending on the area of specialty. However, some of the stressors include poor
working relationship between nurses and other health team members, burn out stress level and
demanding communication and relationship with patients, Understaffed working environment,
lack of support to differentiate mental health problems related to their life, Less Job satisfaction
level and others (Angland, et al. 2014).
Stress has been defined as the circumstances that place psychological demands on a person
through managing the level of stress. Psychiatric nurses need to manage their stress in order to
provide an appropriate care to their patients (Papathanasiou, et al. 2015). Therefore, it is
necessary to nurture and instigate on methods which strengthen the psychiatric nurses to cope
up with job-related stress. The study proposes a critical evaluation of those factors
aforementioned causing stress level and working experiences that are faced by the nurses in
Australia.
Student ID Page 3

OBJECTIVE OF STUDY
The study has the following objectives:
 To determine the causes of the stress among the Psychiatric nurses in Australia with 2
years experiences
 To identify the difference in the mental health nurses and general nurses on the level of
the stress
 To critically evaluate the factors causing the stress level in psychiatric nurses
Student ID Page 4

SCOPE OF STUDY
The scope of the research provides a direction for both general and special practices that are
followed by the nurses (Yoshizawa, et al. 2016). The use of the PICO tool helps to deal with the
clinical scenario. The suggested interventions help to determine the factors that are causing
stress level in the psychiatric nurses.
P- Psychiatric Nurses working in Australia experienced 2 years and above
I- Job Satisfaction level can be improved through rotational working and compensating to the
nurses, limiting the working hours and organizing stress buster programs.
C- Comparison to the level of stress between the general nurses and psychiatric nurses
O- Work stress level is critically evaluated
Student ID Page 5

LITERATURE REVIEW
Job stress is defined as the negative emotion along with the physical responses. In today's
working profession stress is caused by job among usual people, health, and education experts
and other people which are responsible for aiding people i.e. nurses is considered as the top
issues. It is generally caused due to the people working in health and social care centers are
responsible for the health of others and are under the pressure of the different cause of stress.
According to the Foster et al. (2016), new graduates nurses are regarded as precious health
resource with the extent of the experience of 12 months of employment as registered nurses.
The potential reason that emphasized on psychiatric nurses is conflicts with co-workers and lack
of support from the staff. Apart from this, less satisfaction with the head Nurses is contributed
through measuring the negative effect of lack of understanding and support from their
managers. Another measure cause that has been faced by the nurses is the low self-esteem or
lack of confidences. It has been allocated in many clinical areas outside of their choice (Foster,
et al. 2016). The transition from students to registered nurses in Australia is considered to be a
major center of attraction since 1990. The hospital-based learning environment and approach
by health agencies have helped in developing a program which can assist those nurses to deal
with problems. This has provided an opportunity and support to the students and nursing staff
in a formalized way.
Student ID Page 6

METHOD OF REVIEW
A research spanning factors of stress in Australian nurses with the working experiences 2years
and above was included. The analysis focused on the factors of stress and stress outcomes,
along with reviewing the research that examined strategies (Johnson, et al.2017). Qualitative
method is approached in order to determine the factors of increasing level of stress in the
psychiatric nurses.
Search Strategy
Relevant literature was reviewed following the systematic searches of library holdings and
databases, including CINAHL, ProQuest, PsycINFO, MEDLINE (PubMed) and science direct using
the following keywords in various combinations: ‘Psychiatric’, nurse, stress, factors, job
satisfaction and other. The manual searches were performed on nursing journals through the
help of American Nurses Credentialing Centre ANCC published articles. The research was
refined and an academic proven article with the combinational searches beyond the year 2010
has been testified in the study (Wang, et al. 2015). The Cohort and meta-analysis study was
preferred in order to evaluate the critical perspective of the psychiatric nurses. Later on,
secondary research resources were approached they are articles, newspaper, journals,
magazine reference at a lower level.
Student ID Page 7

RESEARCH DESIGN
Papers selected for gaining the information of the research can be assessed by two
independent reviewers for methodological quality (Drury, et al. 2014). The review of perceived
causes of stress among the participant’s i.e. psychiatric nurses has been considered. The most
appropriate design in the study is a qualitative survey of the Australian nurses with experience
of 2 years or more (Hayes, et al. 2015). Qualitative research is possible as it aggregates the
findings to generate a set of quality and similarity. These are subjected to a Meta-synthesis and
comprehensive measures to identify the cause of stress in the narrative form.
Student ID Page 8

LIMITATIONS
The study involves the following limitations (Naseem, 2017).
 The qualitative data collected may contain some limitation which may be included in the
current study
 The sample size depends on the nature of research
 The implementation of the data collection method can flaw the nature of research
 Meta-analysis of the secondary has not been represented appropriately
Student ID Page 9

TIME SCHEDULE
ACTIVITIES/
MONTHS
1 2 3 4 5 6 7 8 9
BEGINNING OF
PROJECT
ADMINISTRATIVE
ALIGNMENT
VIABILITY CHECK
CONSTRAINTS
HUMAN
RESOURCE
REQUIREMENTS
JOB SCHEDULE
ECONOMICAL
ESTIMATION
HAZARD
SUPERVISION
ETHICAL AND
OTHER ISSUES
CHANGE IN
MANAGEMENT
ACTIVITIES
COMMUNICATION
BOARD
APPROVALS AND
FINAL EXECUTION
(Sharon & Dori, 2017)
Student ID Page 10

CONCLUSION
The study is aimed at finding out the main causes of the stress among the psychiatric nurses.
The findings presented the causes are due to the decreases in satisfaction level of job, low self-
esteem, lack of support from people, conflicts with co-workers, interrelated to the problems of
the patients etc. The outcomes of the study include the information of the nurses working in
Australia with experience of 2years or more. It has been revealed that there was a weak
negative correlation between the work stress and job satisfaction in psychiatric nurses. Based
on this, it is highly recommended that nurses must be compensated for their job, must
schedule their job on rotational shifts and organizing the programs supporting stress buster in
the psychiatric nurses (Nurjannah, et al.2014).
Student ID Page 11

LITERATURE CRITIQUE
The misuse of drugs is considered as one of the major global health issues. It is widely spread to
11% of all emergency admissions of drug users and mainly injecting drug users. The study was
carried out by May McCreaddie, Debbie Watt, Imogen Lyons, Elspeth Ewing, Jennifer Tocher.
The study provides a robust account of nurses and drug user’s struggle setting. The Author May
McCreddie is Ph.D., Med, BA, RNT, RN, Lecturer in Nursing and Midwifery Department of the
University of Stirling. While, Imogen Lyons is MPH, BA, Research Assistant at the School of
Nursing and Midwifery and Health systems at the University of College Dublin. And also at
Health Sciences Centre at Bellfield. Similarly the other authors of this research Debbie watt, RN,
Clinical Nurse Speciality at Western General Hospital in Edinburgh. The Journal of Nursing
accepted this research on 2nd March 2010. The main aim of the study is to review the
perceptions of the drug users and strategies that are implemented by nurses with regards to
the acute settings. The drug users present unique challenges in acute care settings with pain
management.
The Injection drug users are likely to face complex problems like comorbidities. The patient who
is drug addicted can harm themselves which requires proper medication from time to time.
However, 86% of the victims stay in the hospital for small tenure i.e. less than a week. The
research design specifies the therapeutic effectiveness of compromised acute settings. The
Qualitative and Constructive grounded theory has been approached in order to incorporate the
data regarding the drug users (McCreaddie, et al. 2010). The comprised interviews with drug
users and focused group recovering from the drug use have loomed through constant
comparative method analysis.
The role of the grounded theory provides information of the strong areas of debate and review
on pre-, intra and post-entry to the field. Drugs users contribute to the irregular discharge rates
among the group of patients. The current evidence to the variety of mechanisms contributes to
the irregular discharge rate to the group of patients. It limits the staff knowledge towards the
Student ID Page 12

presentation of pain management. The increased pain perception of the people develops the
fear plus opioid-induced hyperalgesia syndrome which is responsible for increasing the
sensitivity to minimal stimulus.
Nevertheless, the predictive value of the drug seekers and their behavior explore to the
stigmatize patients through an indistinguishable line. Therefore, nurses are noted to strategize
with the abnormal behavior of the patients and manage the pain management. The comorbid
addicted patient’s compromises to an unsatisfactory experience. The drug users continue to be
admitted to the hospital due to complex features of the behavior. With the potentially fewer
experiences, the challenges faced by the clinicians can result in underpinning the unsatisfactory
clinical processes (McCreaddie, et al. 2010). It can be compromised through therapeutic
effectiveness measures. The study provides an explanation for the perceptions and strategies of
drug users with recognition of broader societal influences. The constructivist grounded theory
provides an in-depth understanding of the flexible approach of the participant. The sampling
with the areas of investigation presents the limited data which exists to represent a broad
spectrum of drug users. The sample was provided from three acute general hospital sites who
work for the same board area i.e. the health of the drug users. The numbers of the participants
involved are the nursing staff and drug users along with them the patient's family. The
involvement of the patient’s family is generally to obtain the written consent of the patient.
Additional research regarding the implication of the grounded theory is presented by the
symbolic interaction of research participants. The data-driven theoretical sampling provides the
commencement of non-acute drug users and possible clinical scenario of drug users. In order to
represent data, it was concluded that the different perspectives are required i.e. involvement of
the people or sampling is needed to be extended (McCreaddie, et al. 2010). The use of the
iterative process to collect the data contribute to achieving a comparison between two
emerging literature. The total data collected contains 11 interviews with the drug users and 5
focused groups. A minimum of four passes was undertaken on each transcript.
Theoretical sufficiency was declared while relating to the developmental theory on the basis of
decreasing data interrogation. The qualitative study provides the reflexivity of simple findings.
Student ID Page 13

The result of emerging data was reported back to the participation of the focus groups through
the dissemination of findings. The grounded theory contends on the moral relativism. Moral
Relativism provides the ethics and code of behavior through social, historical and situated
context. Consequently, moral relativism relates to different moralities which are essential to
align the perspective of the individuals. Thus, the drug users claim on challenges to face the
basic social process (McCreaddie, et al. 2010). The nurses and drug users can constraints on
routines and rituals which underpin the subsequent behavior of protagonists.
Several factors may contribute to the treatment of the drug users through acute care settings.
There is a therapeutic endeavor which arguably enhances the level of satisfaction among the
nurses and self-worth. The behavior practices of the drug users portray the readmission to the
caring centers. The mutuality of caring and therapeutic effectiveness is however compromised.
One of the authors named Corley and Goren has provided stigmatized behavior of the nurses
towards the patients. It has been observed that several drug users suggest a different
compared with other non-drug patients through impeding on good practices. The study
provides clear and distinctive measures on the sensitivity and anxiety (McCreaddie, et al. 2010).
A generalized way to handle the mood of the pre-existing conditions of the drug users is
considered as a part of the comorbid presentation.
Responses from Interviews
The responses from the interviews have focused on the three key dimensions one picks a stitch,
feeling like a piece of shit and anxiety. Unaware of the fact that the focus group acknowledges
about details of the patients recovering drug users. It recounts on the behavioural practice of
the people as it can make one feel worse, angry or disconnected.
Responses from Focused groups
 Stigmatising the thinking of the focus group 1 on infectious diseases that hurt them too
in the normal company. The people believe on three striking claims, One of them is drug
users following environment practices, the immoral pursuit of drugs and arguably moral
judgment are readmitted to the hospital. Several factors that contribute to the need for
Student ID Page 14

acute care setting have been disempowered (McCreaddie, et al. 2010). Therefore,
awareness in the drug users are not so common even they are unfamiliar with fact that
they are drug addict via environment
 Focused group 2 measures the pain management practices for the nurses. It is necessary
to articulate on the prognostic pessimism to threatening and unsuccessful therapeutic
behavior of the drug users. Thus, poor past experiences provide the exacerbated stigma
and sensitivity with reported negative attitudes of the staff towards drug users.
 For Focused group 3 and group of recovering drug user 1, Anxiety and OIH presents a
pre-existing co-morbid presentation of the anxiety cycle. The factors that are taken into
account are managed through withdrawing the pain in drug users through virtually
impossible means of exacerbating anxiety (McCreaddie, et al. 2010). The staff should be
more discreet in dispensing methadone
 Recovering drug user group 2, Sensitivity, however, arises consequences of re-admission
to the hospital as the unfamiliar with the surroundings the drug users may begin to
experience a straight place with recovering drug recounts. The drug recover provides
the significant details of the admission of the overdose people and unidentified staff
members feel like a piece of shit appears. It refers to worthless and unfair quick
irregular discharges in a straight place.
 The third group of the recovering and drug users is present as which are responsible for
their health term. This particular patient group provides subsequent self-discharged
measures of the groups that are inflexibly addressing to the anxiety, pain, and
withdrawal of the people. The underlying physiological processes at work are uncertain
with the exacerbating tense situations (McCreaddie, et al. 2010). This corresponds to
rituals and routines of that are faced by the nurses to acute admissions of the drug users
as per their situations.
The nurses are responsible to provide a control on the routines of the hospital with the help of
the authority. The perceived threat that may occur provides individual values and sense of self-
worth challenges that are created with greatest respective realities, moralities, and needs. The
Student ID Page 15

rattling is defined as the onset withdrawal of both rituals and routines to create the greatest
challenge.
It can be concluded that the moral relativism and its subcategories are considered as the main
drivers of protagonists (McCreaddie, et al. 2010). The processes that are underpinned provide
the interactions measures with the purpose of remedying the aberrant behavior of both parties
and their implications for practices. Other than the drug the perennial problem that has been
faced by the people due to their addictive behavior is the urine screens. Therefore, it is
necessary to spread awareness about those problems. Moreover, to provide training the nurses
is efficient in order to handle the emotional problems of the patients. The initiatives taken by
the nurses develop their fundamental skills and help them to treat those patients. There are
some deficiencies which influence their choice of career. They are attitudes, values, and beliefs.
Further, it suggested that the proactive pain management is associated with the level of the
interaction with the old-fashioned communication measure i.e. nomenclature communication.
Beyond the prospects, there are certain limitations which are discarded the study on some
aspects. They are:
 The contractual issues were condensed on the basis of timeframe
 Even majority of the data collection measures were an encounter for a shorter period
 A diversity of data collection has provided sufficient breadth and depth to the categories
and theories
 Staffs those who were recruited for the focus groups have comprised dual qualified
nurses
Thus, despite technological and pharmaceutical advancement pain management remains
problematic for the patients (McCreaddie, et al. 2010). The process of moral relativism can help
in overcoming those measures that are essential for the drug users in acute care setting have
been discussed. However, it is necessary to improve the pain management of drug users in
order to subtleties interactions with the patients and the processes that benefit them all. Quick
technologies have helped in fixing the issues like urine screens and another transient effect of
Student ID Page 16

cognitive education. Thus, the enlightenment to the need of meaningful perceptible group of
patients has been encountered in the study.
REFERENCES
Angland, S., Dowling, M., & Casey, D. (2014). Nurses’ perceptions of the factors which cause
violence and aggression in the emergency department: a qualitative study. International
emergency nursing, 22(3), 134-139.
De Looff, P. C., Kuijpers, E., & Nijman, H. L. I. (2014). Stress levels of psychiatric nursing staff.
Drury, V., Craigie, M., Francis, K., Aoun, S., & Hegney, D. G. (2014). Compassion satisfaction,
compassion fatigue, anxiety, depression, and stress in registered nurses in Australia: Phase 2
results. Journal of Nursing Management, 22(4), 519-531.
Foster, J., Taylor, C., Patterson, T., & Psaila, K. (2016). Experiences of new graduate nurses
working in a neonatal intensive care setting: a systematic review protocol of qualitative
evidence. JBI database of systematic reviews and implementation reports, 14(10), 105-111.
Hayes, B., Bonner, A., & Douglas, C. (2015). Research Design. JOB SATISFACTION, STRESS AND
BURNOUT IN HAEMODIALYSIS NURSES, 105.
Johnson, J., Hall, L. H., Berzins, K., Baker, J., Melling, K., & Thompson, C. (2017). Mental
healthcare staff well being and burnout: A narrative review of trends, causes, implications, and‐
recommendations for future interventions. International journal of mental health nursing.
McCreaddie, M., Lyons, I., Watt, D., Ewing, E., Croft, J., Smith, M., & Tocher, J. (2010). Routines
and rituals: A grounded theory of the pain management of drug users in acute care settings.
Journal of clinical nursing, 19(19 20), 2730-2740.‐
Naseem, K. (2017). Job Stress and Employee Creativity: The mediating role of Emotional
Intelligence. International Journal of Management Excellence, 9(2), 1050-1058.
Student ID Page 17

Nurjannah, I., Mills, J., Usher, K., & Park, T. (2014). Discharge planning in mental health care: an
integrative review of the literature. Journal of Clinical Nursing, 23(9-10), 1175-1185.
Papathanasiou, I. V., Tsaras, K., Neroliatsiou, A., & Roupa, A. (2015). Stress: Concepts,
theoretical models and nursing interventions. American Journal of Nursing Science, 4(2-1), 45-
50.
Sharon, A., & Dori, D. (2017). Model Based Project Product Lifecycle Management and Gantt‐ ‐
Chart Models: A Comparative Study. Systems Engineering, 20(5), 447-466.
Wang, S. M., Lai, C. Y., Chang, Y. Y., Huang, C. Y., Zauszniewski, J. A., & Yu, C. Y. (2015). The
relationships among work stress, resourcefulness, and depression level in psychiatric nurses.
Archives of psychiatric nursing, 29(1), 64-70.
Yoshizawa, K., Sugawara, N., Yasui-Furukori, N., Danjo, K., Furukori, H., Sato, Y., ... & Nakamura,
K. (2016). Relationship between occupational stress and depression among psychiatric nurses in
Japan. Archives of environmental & occupational health, 71(1), 10-15.
Student ID Page 18