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Problems Associated with Adult Nursing Practice

Introduction:

The nurses are the integral part of the healthcare system providing the quality care service to all the patients and participating in the leadership role of their organisation. The five major problems faced by the nurses in the profession of health care are shortage of nursing staff, workplace stress, exhaustion due to the long working hours, violent activities of the patient i.e., the work place hazards. Most of the graduate nurses when they started working felt that this was not the service that they looked for and most of the time they quit the job. They experience exhaustion because of the above mentioned factors. According to the facts provided by the American Holistic Nurses Association, the nurse experiences most of the work place associated stress in comparison to the staff members of other profession. Most of the work place stress includes the following parameters such as the management issues, demanding the physical presence of the nurse, lack of resources and the difficulties that nurses face to balance the work and home life due to the long exhausting working hours. The term burnout with respect to the nurses denotes the poor physical, emotional and the mental state of the nurses due to the persistent work pressure and the lack of fulfilment of the job related desires, support and lower level of confidence or personal accomplishment. An effective nursing care includes the various aspects of caring, understanding by being non judgemental to the patients and should have the ability to empathize the patient coming from all spheres of life. They need to care for the sick, injured, mentally abnormal and about to die patients on the daily basis therefore the nurses should be at their highest potential of providing the professional service apart from being mentally and physically sound. Therefore systemic literature review on the problems faced by the nurses mostly due to the workplace associated stress, shortage of staff members and worsening of their health should be considered which will help every organisation to manage these problems. Moreover, studies related to the management of the stress and mental health disorders among the nurses should also be reviewed to provide a reliable outcome to the above mentioned crucial problem. For students seeking healthcare dissertation help, our service is going to provide comprehensive support and guidance tailored according to your needs. From starts from topic selection to research methodology and writing assistance. We offer expert guidance to ensure the success of your dissertation.

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Background:

According to the definition of Health and Safety Executive (Kerr, et al, 2009) the term stress can be defined as “the adverse reaction people have to excessive pressure or other types of demand placed on them”. The stress related to the work and work places are extremely frequent among the workers of the healthcare profession especially among the nurses which accounts up to 40 percent. The occupational stress is also considered to be the major cause of death throughout the world and increases the risk of specially the cardiovascular problems (Kenny, et al, 2003). Several factors are associated with stress that are chiefly responsible for low productivity, absenteeism and lower level of self confidence such as the apparent loss of interest in the work concerned, persistent fatigue, impairment of the cognitive abilities, stress induced insomnia or hypersomnia, sudden increase in the appetite of the person, decreased level of energy, depression, exhaustion and ultimately suicide. Several studies have also reported that the workers who are working under high stress level are imposing more cost to the company which is up to 46 percent in comparison to the non stressed workers and the workers who are showing the signs of depression the cost estimate can rise up to 147 percent (Edwards, et al, 2008).

The concept of holistic nursing practice is related to the aspect of mindfulness which can be defined as a transformative process in which one develops enhanced capability to “experience being present” with the “acceptance, attention and awareness” (p. 282, White, 2014). The application of this kind of attitude in the holistic practice of nursing will definitely reduce the percentage of the nursing errors and enhance the quality of the patient service which is a matter of concern for all organisations (Hall, Johnson, Watt, Tsipa, & O’Connor, 2016). As per the reports of the NHS Staff and Learners’ Mental Wellbeing Commission (HEE, 2019) which focused on the fact that one out of three staff members of NHS had felt unwell because of the pressure and the work associated stress and the percentage of similar incidents had risen up to the level of 1.3 percent in comparison to the data of previous year. The absent rate of the staff members of NHS increased to 4.5 percent which estimated to the cost of about £1.1 billion (HEE, 2019). So the plan of NHS is to reduce the percentage rate to 3.5 percent within 2020 which also lower down the cost and the estimated save will be up to £120 million per annum. The statistical data also stressed on the findings that about 350,000 staff members of the NHS in between 2012 to 2018 have left the organisations based on several reasons apart from retirement and therefore the estimated cost of staff retention was increased up to £100 million per annum (HEE, 2019). The statistical findings obtained from the office for national statistics stated that 305 nurses committed suicide in between the year of 2011 and 2017 and the estimated risk of committing suicide among the female health workers were found 24 percent higher in comparison to the national female averages (ONS, 2018). This particular aspect of suicide committed by the nurse is considered to be a very critical issue and therefore the well being of staff members of NHS is extremely important. The aspect of well being includes the following parameters such as the quality of patient care service provided by the staff members, the ability of the staff members to meet demands of the work and the aspect of staff retention (Hawker, 2012)). The particular situation demanded the coping strategy skills of the staff members along with the well being of staff members all contributing as a whole to the quality patient care service. It is mandatory by law the employers have the duty to protect their employees as mentioned in the Health and Safety at work Act (1974). Therefore NHS had committed to the aspect of health, safety and well being of their staff members and it is evident from the framework of NHS Health and Wellbeing (2019) (Alexis, 2011). NICE (QS147) (2017) had also introduced major quality related standards for the physical and the mental well being of the staff members as it is considered to be an essential factor for the organisational policy of health care sector.

Another aspect also contributes to the stress of the nursing staff which is the shortage of the staff members. As per the report of current trends, there will be huge shortage of the nursing staff members by the end of 2030 (Juraschek, Zhang, Ranganathan, & Lin, 2012). In countries like Taiwan about 9 percent of the total nursing positions are still not fulfilled and as a whole the vacancy rate is greater than 5 percent. As with the passage of the time the demands for the health care staff are increasing which is creating pressure on the existing nursing staff (Chang & Lin, 2016; Chiu, 2012). The transition phase of a newly graduated nurse to a staff nurse is highly stressful. According to the findings of a study the nursing staffs faces a lot of exhaustion not only because of the work environment but also due to the persistent interaction with the patients and their families. Moreover, the recent qualified nurse had to give proper time to their duties to learn many new aspects which would help them to provide the quality care service. Within the first two years of service the newly graduated nurse faces a lot of stress and the psychological problems due to their reduced competency to deal with the most challenging patients and certain emergency situation due to which they often decide to quit. Therefore the organisation should keep nursing managers and educators to deal with the newly graduated nurses by reducing their work related stress and encouraging them not to quit their jobs is an essential aspect.

The management of stress has been addressed with various kinds of theories in the past which highlighted on the fact that stress is the direct outcome of the interaction of a person with the immediate environment (Lazarus, 1984). The term burnout was introduced by Freudenberg (1974) which helped to describe the impact of stress. Another tool which is used to measure the burn out of the staff members is Maslach Burnout Inventory (MBI) (1981) which is basically a survey process based on the self reports examining about the three dimensions of burnout. This particular tool is considered to be reliable and valid for the investigation purpose. There are several other non pharmacological interventions which can be used to manage the varied level of psychological stress such as depression, anxiety and stress (Burton et al, 2017). The Mindfulness Based Stress Reduction (MBSR) was developed by Jon Kabat-Zinn which applies the mechanism of “paying attention to the inner and outer experiences in a non judgemental manner from moment to moment” (Kabat-Zinn, 2003). This particular practice of mindfulness works by activating the neuro anatomical circuits which will in turn regulate emotion and observes the response of the body. So this particular intervention of mindfulness was found to be quite effective in reducing the psychological parameters such as stress, anxiety, emotional burn out and depression among the nurses (Gauthier, Meyer, Grefe, & Gold, 2015). Therefore, this concept of mindfulness should be applied in the nursing practice to promote the well being and health of the nurse so that they can offer holistic patient care service to the patient (White, 2014). Several studies have reported about the correlation between the stress and the mental health and the acute physical health problems (Barlett, Taylor & Nelson, 2016; Kang, Choi, & Ryu, 2009). When the condition was compared to the existing population norms, the participants of the Mindfulness Centred Stress Reduction Study (MCSR) focused about the lower quality of life in all the four domains which includes the physical health aspect, the psychological health, the social relationships and the environment. Therefore the particular study has validated the fact of nursing stress impacting the health of newly graduated nurse. The outcomes of the study as claimed by the authors that the student nurse should depend upon accurate coping strategies for the reduction of stress which would help them to provide the quality patient care service as expected by the organisation (Shirey, 2007). The incorporation of the aspect of mindfulness in graduate level of the nursing health program will help to augment the student’s health by reducing their stress level which will ultimately help to improve the quality of the patient service. Moreover, NICE (CG90, 2018) has also recommended the application of Mindfulness Based Cognitive Therapy (MBCT), which is a group based program, for the management of several mental health disorders such as depression, anxiety and stress. Researchers have also applied the MBCT program for a period of five weeks with a session of two hours per week and in between practice sessions. This was incorporated within the nursing education programme of the hospital. The mental health disorders were measured in terms of the Perceived Stress Scale (PSS) and the Depression Anxiety Stress Scale (DASS). Similarly to assess the well being or the healthy outcomes the Mindfulness Attention And Awareness Scale and the Subjective Happiness Scale (SHS) were applied. After the completion of the whole program, the statistical analysis of the findings stated that the participants reported substantial improvement in the Stress level, Depression level, happiness and the health with the application of the program. Several authors have also reported that the application of mindfulness is effective to build resilience among the health care professionals (Burton, et al., 2017, Guillaumie and Boiral, 2016). Therefore, this study has aimed to investigate about the work place associated stress of the nurses and the impact of the stress on the mental and physical health of nurses. The study will also look into the aspect of the various interventions that can be used to manage the stress and mental health disorders among nurses by the execution of an appropriate project plan and analysing the findings of the study.

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References:

Kerr, R., McHugh, M. and McCrory, M., 2009. HSE Management Standards and stress-related work outcomes. Occupational medicine, 59(8), pp.574-579.

Kenny, D.T. and Cooper, C.L., 2003. Introduction: Occupational stress and its management. International Journal of Stress Management, 10(4), p.275.

Edwards, J.A., Webster, S., Van Laar, D. and Easton, S., 2008. Psychometric analysis of the UK Health and Safety Executive's Management Standards work-related stress Indicator Tool. Work & Stress, 22(2), pp.96-107.

White, L., 2014. Mindfulness in nursing: An evolutionary concept analysis. Journal of advanced nursing, 70(2), pp.282-294.

Staff, N.H.S., 2019. Learner’s Mental Wellbeing Commission. Health education England, February.

Hall, L.H., Johnson, J., Watt, I., Tsipa, A. and O’Connor, D.B., 2016. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11(7).

ons.gov.uk (2018) Office for National Statistics [online] Available at: https://www.ons.gov.uk/ (Accessed on:10.02.2020)

Hawker, C.L., 2012. Physical activity and mental well-being in student nurses. Nurse education today, 32(3), pp.325-331.

Alexis, O., 2011. The management of sickness absence in the NHS. British Journal of Nursing, 20(22), pp.1437-1442.

Juraschek, S.P., Zhang, X., Ranganathan, V. and Lin, V.W., 2012. United States registered nurse workforce report card and shortage forecast. American Journal of Medical Quality, 27(3), pp.241-249.

Chang, H.L. and Lin, C.F., 2016. Taiwanese registered nurses' reasons for failure to practice. International Journal of Nursing & Clinical Practices, 2016.

Lazarus, R.S., 1995. Psychological stress in the workplace. Occupational stress: A handbook, 1, pp.3-14.

Burton, A., Burgess, C., Dean, S., Koutsopoulou, G.Z. and Hugh‐Jones, S., 2017. How effective are mindfulness‐based interventions for reducing stress among healthcare professionals? A systematic review and meta‐analysis. Stress and Health, 33(1), pp.3-13.

Kabat‐Zinn, J., 2003. Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), pp.144-156.

Gauthier, T., Meyer, R.M., Grefe, D. and Gold, J.I., 2015. An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. Journal of pediatric nursing, 30(2), pp.402-409.

Bartlett, M.L., Taylor, H. and Nelson, J.D., 2016. Comparison of mental health characteristics and stress between baccalaureate nursing students and non-nursing students. Journal of Nursing Education, 55(2), pp.87-90.

Kang, Y.S., Choi, S.Y. and Ryu, E., 2009. The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse education today, 29(5), pp.538-543.

Shirey, M.R., 2007. An evidence-based solution for minimizing stress and anger in nursing students. Journal of Nursing Education, 46(12).

Guillaumie, L., Boiral, O. and Champagne, J., 2017. A mixed‐methods systematic review of the effects of mindfulness on nurses. Journal of advanced nursing, 73(5), pp.1017-1034.

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