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Understanding and Addressing Workplace Stress Among Mental Health Nurses

According to the definition of Health and Safety Executive mentioned by Zeller (2013), 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. According to McVicar (2013), 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. 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 (Evans et al., 2012; McIntosh et al., 2013). If you are a healthcare professional facing stress-related challenges, consider seeking healthcare dissertation help to mitigate these issues effectively and efficiently.

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. 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.

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Apart from the usual stress experienced by the general nurses, the nurses working in closed units with high patient acuity levels faces additional stress as the patients of this ward are aggressive or violent in nature, have no certainty in their behavioural patterns and may cause sudden harm to themselves or others living in their vicinity. Their job hardly rewards them with any positive outcome which demoralizes their sense of reward. One vital aspect of mental patient nursing that the nurses should always remain cautious about any upcoming danger to themselves or to others but cannot take any action against them. Therefore they face complicated ethical dilemma about their role and confrontational attitude problem while dealing with the mental health patients. All these factors results in the development of severely high level of stress among the mental health nurses. A systemic study conducted by concerning the major stressors experienced by the mental health workers are the conflict regarding the role, the role ambiguity and the fulfilment of the statutory responsibilities based on the Mental Health Act, 1983. The MHNs suffers from high level of dissatisfaction regarding the personal achievement from their work, the excessive workload, does not feel valued as a female employee. The nurses also suffers from the emotional exhaustion because of the work related stress, due to the degree of association with the patients, the absence of the support from the organisation and conflicts associated with the role. The sources that were identified were the absence of the supervision, lack of support and poor resourcing. The other factors that were identified were the scarce of time to perform the concerned duties, the fulfilment of the imposed deadlines and also meeting the emotional needs of the clients (Lu et al., 2012; Rose et al., 2015).

Coping strategies:

As per the reports of the NHS Staff and Learners’ Mental Wellbeing Commission (Health Education England, 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 (Health Education England, 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 (Health Education England, 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 (Office for National Statistics, 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 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. Stress level can be effectively managed with the implementation of effective coping strategies which is considered to be a multidimensional parameter including the cognitive and the behavioural patterns by the researchers.

Stress and Depression:

There is relatively a higher tendency for mental health nurses to be involved with incidents and situations that arouse physical and emotional aggressions leading to post-traumatic stress disorders (PTSD) as well as burnout or exhaustion that arises due to excessive physical and emotional demands, as a comparison to their counterparts in other health institutions. Hall et al. (2016) highlighted the fact that their job requirements can lead to extreme emotional exhaustion and anxiety. The dual symptoms of depression and stress developed among the nurses working in the mental health ward reduce the efficiency of the quality care provided by them. Several parameters such as workplace stress, the exhaustion of the physical and mental health, absence of control and lack of coping strategies among the mental health nurses eventually results in depression. A study highlighted the direct relation between the stress level at the psychiatric ward with the depression level of the mental health nurses and it is negatively linked with the resourcefulness. Another aspect also contributes to the stress of the nursing staff which is the shortage of the staff members. The transition phase of a newly graduated nurse to a staff nurse is highly stressful. To this end, current studies have identified a strong link between staff stress and patient safety and effect on the quality of care delivered to patients (Hall et al., 2016).

Interventions to reduce stress:

Interventions aimed at reducing stress and its impact on MHNs may be focused on evaluations of nurses at pre and post-traumatic incidence. According to Olashore et al. (2018) the implementation of pre-placement personality evaluation of the staff members working at the psychiatric wards and post-trauma counselling of those members who were exposed to violent and aggressive behaviour will be extremely beneficial to reduce the frequency of PTSD among the mental health workers. The author McIntosh et al. (2013) also mentioned that increasing the number of friends and social support obtained from families will be useful to reduce the negative effects of secondary traumatic stress among the MHNs. Another author Simães et al. (2019) stressed on the fact that interventions should be taken to categorize the perception of work stress as a potential threat and should uptake the job of MHNs as challenging and controllable. McIntosh et al. (2013) proposed that policies and procedures at the workplace should focus on the security, reporting and surveillance of the environment and education for all. A systemic review study was conducted in UK between the years 1999 to 2006 on the aspects of stress management interventions especially of the MHNs by utilizing the primary research articles on stressors and the outcome of the stress highlighted about 176 papers and among them only 70 studies met the inclusion criteria of the study. A total of 69 papers highlighted about the stressors and the stress outcomes and only 8 studies focused on the interventions for the management of stress. The identified stressors mentioned in the study were the job dissatisfaction and the exhaustion of the MHNs and the stress management techniques identified within the studies for the MHNs were training on the behavioural techniques, techniques on relaxation, workshops and training on the therapeutic skills for the management of stress of MHNs. The factors that are mentioned to affect the job satisfaction of the nurses were: 1) when they are dealing with a difficult case; 2) the feeling they achieve by helping the patient; 3) they can share their skills; 4) when they are the part of the team that is working well; 5) securing the opportunities to develop themselves; 6) they should have the power of making decisions and flexibility (Happell et al., 2013).

The Schwartz Center Rounds (SCR) brings doctors, nurses and other care providers together to explore the social and emotional aspect of caring for patients and their families (Taylor et al., 2018). It is a multidisciplinary meeting conducted by trained professionals formulated for the staff members of the hospital to encourage the compassion and communication between them. The SCR is considered to be a unique example of an organization wide intervention which has spread at a rapid rate among the healthcare organization of the United Kingdom. Although current evidence-based research conceptualising the effectiveness of SCR for managing healthcare staff wellbeing is limited, their adoption in the UK was extremely fast (Taylor et al., 2018). The implementation of this approach during the attendance at the round was related to the enhanced level of compassion towards the patients, reduced the stress level among the staff members of the organisation, enhanced level of team work and as a result a positive impact can be observed on the cultural practice of the organisation.

Gaps in the available literatures:

Very few literatures are available on the success of Schwartz Center Rounds (SCR) for the management of wellbeing of health care staff of the organization in the United Kingdom. Moreover, the implementation of the particular approach has to be studied in details among the newly qualified mental health nurses and its associated advantages also have to be studied. As evident from the other literatures the implementation of this particular approach enhances the compassion of the staff members towards the concerned patient and also reduces the stress level of the members. Therefore, the present study aimed to propose the innovation idea on using Schwartz on newly qualified mental health graduates, it will analyse and evaluate the effectiveness of using Schwartz Rounds to monitor emotional stress related the work place stress among the newly qualified MHNs.

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References:

Evans, G. W., Becker, F. D., Zahn, A., Bilotta, E., & Keesee, A. M. (2012). Capturing the ecology of workplace stress with cumulative risk assessment. Environment and Behavior, 44(1), 136-154.

Elsayed, S., Hasan, A. A., & Musleh, M. (2018). Work stress, coping strategies and levels of depression among nurses working in mental health hospital in Port-Said city. International journal of culture and mental health, 11(2), 157-170.

McIntosh, B., & Sheppy, B. (2013). Effects of stress on nursing integrity. Nursing Standard (through 2013), 27(25), 35.

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

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

Zeller, J. M., & Levin, P. F. (2013). Mindfulness interventions to reduce stress among nursing personnel: An occupational health perspective. Workplace health & safety, 61(2), 85-89.

McVicar, A., Munn‐Giddings, C., & Seebohm, P. (2013). Workplace stress interventions using participatory action research designs. International Journal of Workplace Health Management.

Olashore, A. A., Akanni, O. O., Molebatsi, K., & Ogunjumo, J. A. (2018). Post-traumatic stress disorder among the staff of a mental health hospital: Prevalence and risk factors. South African journal of psychiatry, 24(1).

Simães, C., & Gomes, A. R. (2019). Psychological Distress on Nurses: The Role of Personal and Professional Characteristics. In Occupational and Environmental Safety and Health (pp. 601-610). Springer, Cham.

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

Taylor, C., Xyrichis, A., Leamy, M. C., Reynolds, E., & Maben, J. (2018). Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews. BMJ open, 8(10).

Happell, B., Dwyer, T., Reid‐Searl, K., Burke, K. J., Caperchione, C. M., & Gaskin, C. J. (2013). Nurses and stress: recognizing causes and seeking solutions. Journal of nursing management, 21(4), 638-647.

Lu, H., Barriball, K. L., Zhang, X., & While, A. E. (2012). Job satisfaction among hospital nurses revisited: a systematic review. International journal of nursing studies, 49(8), 1017-1038.

Rose, D., Evans, J., Laker, C., & Wykes, T. (2015). Life in acute mental health settings: experiences and perceptions of service users and nurses. Epidemiology and psychiatric sciences, 24(1), 90-96.


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