Table of Content
Introduction: The Concept of Stress
Concept of Stress and Burn-out
Stress and Nursing Professionals
Perspectives on Stress Management Interventions (SMI)
Stress appears to be a normal response to certain agency that requires the application of our capabilities to adapt to changing environmental conditions. In the care of patients, the working environment typically encompass well-defined structures such as healthcare institutions (regardless of their levels of expertise) or informal settings commonly found in many resource-limited settings where access to formal institutions may be temporarily or permanently unavailable.
The present work focuses on the subject of burn-out among nursing professionals owing to a myriad of factors. It highlights the phenomena of stress in the workplace and individual’s lives of nurses; existing assumptions on burnout as an indicator of stress and its mechanistic pathways within a health organization. This is followed by literature analysis of research works on the impact of burnout, in particular, as barrier to achieving the ultimate goal of quality and safe patient care and the role of positive psychology.
In sum, it is imperative that the promotion of health and the prevention of health problems (particularly among nurses) should majorly be focused on creating a work environment that does not induce an unnecessary amount of stress and that can compensate for unavoidable stress in the form of increased control and rewards for workers among other incentives.
Introduction: The Concept of Stress
The term ‘stress’ hardly has a general consensus in its meaning among various researchers. Several arguments have been put forward as described below. McGrath (1976) (cited in Moustaka & Constantinidis, 2010) argued that stress ensues when a person perceives a high demand on their personal capabilities from the environment. Such high expectation and demand may elicit fear reactions and stress. Williams and Huber (1986) theory in a way supports this argument viewing the persistent high demand of one’s capabilities as akin to the perception of threat from internal or external sources in a particular circumstance. Arnold and Feldman (1986) posits that such ‘stressful’ response is individual-dependent. French et al. (1985) postulates on the indiscriminate nature of stress – the phenomenon of stimulating a response (either burn-out or rust-out) “…when we surpass our limitations or we are below them” as we exhibit our capabilities in the presence of a ‘threat’ or challenging situation.
In short, the sources of the ‘threat’ will be addressed subsequently as it concerns the workplace (in this case, the healthcare institutions).
Concept of Stress and Burn-out
There is a widely accepted assumption that individuals at some point (either in their personal or professional lives) would have to face conditions that are geared to enhance their performance, capabilities and general quality of life (Tehrani & Ayling, 2009). On the other hand, there are also awareness on setbacks to personal and professional life brought by inability to manage the stress levels within the environment, often manifesting as “…loss of productivity and working hours, development of diseases, workplace accidents among others” (Lazarus and Folkman, 1984 cited in Moustaka & Constantinidis, 2010). Researchers have exposed some of the negative responses to stress to include gastric ulcer, hypertension, asthma, heart attack, anxiety, burnout, amnesia and fussiness to mention a few (Tehrani et al., 2012).
As indicated earlier, as individual enter various transition in their personal and professional lives; they encounter threats, unfamiliar events or challenges that Matteson and Ivancevich (1987) (in Kumari and Mishra, 2009) identified as stressors or stress-causing agents. Their response to these stressors therefore is what is perceived as stress. It has also been described as a reaction to “… change in the environment which is often associated with danger, challenge or threat to an individual’s stable condition” (Smeltzer et al., 2008; Gorgich et al., 2017).
Although this discourse is focused on the nurse as a professional; various studies have demonstrated how an individual’s personal life is inextricably linked to their capabilities to manage stress at the workplace. Conceptually, there is a relationship between “health, relationship and financial challenges on the home front, and being able to cope with the demands of patient care, and other external forces in their work environment” (Bromberger & Matthews, 1996; Rothmann, Van Der Colff, & Rothmann, 2006). Understanding this relationship is pivotal to addressing the consequent outcomes of poor stress management decisions perceived as “… burnout, job satisfaction and health outcomes through a pattern of physiological, emotional, behavioural and cognitive processes” (Young, Schieman & Milkie, 2013).
The next section is focused on stress in the working environment of nurses.
Stress and Nursing Professionals
Having a robust health workforce is a significant indication of a strong health system, and to a large extent, the performance of a health organization is predicated on collective state of the capacities of individuals that make up the health workforce (Kumari & Mishra, 2009). There are therefore, increasing calls for policies that ensure that health administrators and managers provide optimum working conditions for employees as a way of bolstering their productivity.
Kumari and Mishra (2009) worked on “…identifying stress-related factors that positively and negatively affect performance of medical professionals.” Their report indicated some of the common stressors that affect many individuals particularly in clinical or non-clinical environments such as “… overload, role conflict, and general lack of clarity in job specifications.” Meanwhile, contrarily to overwhelming assumptions, stressors may either present as opportunities or barriers to the growth of individuals. In other words, positive stress present individuals with opportunities for having or doing what they desire. Negative stress on the other hand, is characterized by overwhelming and undesirable barriers or demands on the individual. This is otherwise known as distress in certain literature (Ravalier et al., 2020).
Most workplace stress have been profiled in scholarly works such that undesirable work-related conditions are found to be unintentionally or innately created leading to transformation in the health status of individuals, “…reinforcing deviation from normal functioning” (Beehr & Newman, 1978).
Distress in the workplace as defined by the United Kingdom Health and Safety Executive (HSE) is “the adverse reaction individuals have to excessive pressures or other demands placed on them” (Ravalier et al., 2020).
There are many sources of stress for healthcare providers including stress associated with providing care to patients (Kabirzadeh et al., 2008); when stress become persistent, it could lead to the phenomenon known as “physical and mental burnout (Gorgich et al., 2017). This is in agreement with Beddoe and Murphy (2004) that found the work-related stress can increasingly affect worker’s mental and physical health. It is also consistent with studies by Piko (2006) and Khamisa et al. (2016) that correlated poor physical and psychological health outcomes with work-related stress and burnout.
Ravalier, McVicar and Boichat (2020) study characterised workplace stress among employees of the National Health Service (NHS) based on the background of “higher-than-average level of stress-related sickness absence of all jobs sectors in the country.” From the study, it was reported that the health and social care occupational sectors had the highest levels of stress-related sickness absence in the country, estimated to be 46% higher than the United Kingdom (UK) average (Rimmers, 2018). Of this statistics, job-related stress leading to poor health outcomes accounted for approximately 40% of absenteeism (Rimmer, 2018); consequently, leading to financial losses of “…up to £400 million” annually (NHS, 2020).
In the discourse on distress ensuing from fulfilling the overwhelming physical and mental demands of the workplace, it is important to acknowledge why the subject is important for the healthcare professional (notably, the nurse) who is typically confronted by a myriad of hazards that threaten their health, as defined by the World Health Organisation (WHO). The WHO definition typically expands the health of individuals in multidimensional fashion including physical, mental and social (Behrouzian et al., 2009; Samiee et al., 2011).
In recent times, many public debates have been centred on allocation of financial resources to create the ideal work environment for health workers and the expected dividends (Lu, Chang & Lu, 2007). The health statistics on budgetary allocation for such purposes that reflects the conditions of the working environment is often reported to be worse in resource-limited countries such as in sub-Saharan Africa.
As noted by Gorgich and other researchers, nurses due to their role in the health system are highly impacted by the stressful work environment compared to other professionals” (Gorgich et al., 2017). In fact, they are estimated to constitute a high demand of approximately 80% of the healthcare providers (Ghasemi & Attar, 2008).
Meanwhile, the WHO in one of its reports ranked nursing professionals high in terms of health problems (risks to occupational hazards) - “…27 out of 130 stressful jobs” (Sepehrmanesh et al., 2003).
Further, based on the extensive empirical studies of the effect of burn-out and other distress signs on nurses; a number of contributory elements to raise the potential for burnout among nurses have been identified including “…working environment, interpersonal relationship, role characteristics among others” (Moustaka and Constantinidis, 2010; Gorgich et al., 2017; Khamisa et al., 2017). This is as depicted in table 1 below.
Table 1: Sources of Burn-out among nurses
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