Abstract
The primary purpose of this systematic analysis was to identify and integrate evidence on job stress and resilience using an example of the Australian nursing staff. A literature survey was performed using MEDLINE, Web of Science, and Scopus, and it was only limited to written works between 2008 – 2018. The analysis included both comparative and quantifiable data; out of the 41 papers that met the inclusion test, nineteen used qualitative and quantitative research analysis, 27 (65.85%) were quantitative, and 12 (29.26%) employed qualitative data. Furthermore, 4.87% (2/41) addressed workstation stress and toughness, 46.34 (19/41) tackled stress, and 48.78% (20/41) dealt with resilience issues.
Of the 41 papers, 40 met the criteria for high methodological quality assessment, while only one paper had medium quality. The analysis showed that most of the caregivers usually face moderate to high degrees of stress. In addition, the clinicians embrace various business resources such as informal and formal support services, role modeling, and leadership to create toughness. Moreover, therapists employ personal traits like positive attitude, self-confidence mechanisms, self-reliance, and work-life synergy to manage stress.
One of the recommendations is that more attention be directed towards educational interventions to attain tenable advancements in nurses’ health and mental stability. The registration number of the systematic review is 12662. The limitations of the review are largely related to language limitation, time of publication of the included papers and scope.
Introduction
Several contextual and theoretical methods have been used to describe toughness historically. Resilience is a flexible and dynamic theory concerning counteracting adversity inside the personal transformative and developmental continuation frameworks. Therefore, resilience is the capability of groups, families, and individuals to work successfully, adapt, and cope regardless of sociological, physical, psychological, or ethnic inclusiveness (Badu et al., 2020). Several measures have been put in place to alleviate workstation’s stress, adverse impacts and mitigate negative psychological outcomes among clinicians. Some of the consequences of resilience involve understanding positive adaptation, personal development, sound mind and body, and socio-psychological adjustment.
At the same time, numerous studies have advanced theoretical frameworks to ease knowledge of resilience among caregivers working in healthcare settings. The predicting elements employed to create toughness in the places of work by nurses can be grouped according to external, business, or individual factors. The personal characteristics are internal factors and comprise cognitive ability, positive sense of identity, neuroplasticity, and personality traits. On the other hand, the institutional resources are generally supported by supportive working conditions, professional skills development, bio-psychosocial programs, and interventions executed by workstation organizations.
Researchers have suggested that mentoring, motivation, role models, and selflessness should be encouraged to facilitate resilience in the nursing career. There is increasing evidence in Australia concerning the impacts of stress among professional nurses. Toughness and its related adapting measures should be used to prevent the job stress encountered by clinicians. An exploration study being part of this integrative analysis spotted two papers that sought to produce evidence on coping methods, stress, and resilience models among the workplace physicians in Australia. One of the researches targeted the stressors, the stress-related impacts on health, and the adapting mechanisms. At the same time, the other dealt with stress even though it was limited to hematology nurses.
The determinations are essential because the findings are expected to inform policy decision-making of the nursing workforce’s welfare and inspire human resource management for wellbeing. The evidence will also be valuable to managers and policymakers in reducing burnout and stress in the nursing labor force. Lastly, it will guide analysts, clinicians, and investigators regarding future studies to facilitate resilience among students and working caregivers globally.
Methods
The approach employed here is a collaborative review that enables simultaneous incorporation of observational, multiple perspectives, and experimental research to deeply comprehend the phenomenon of concern. The primary purpose of this approach is to utilize different sources of information to create a holistic view of resilience in the nursing profession. Furthermore, this method entails several stages: identifying the problem, evaluating and analyzing data, literature search, and presentation. The review excluded papers that did not tackle resilience in nursing, focused on toughness in institutions outside nursing conditions, and targeted nurses in an academic setting, fresh graduates, and nursing students.
The search strategy included all peer-reviewed printed papers answering the coping skills and toughness employed in stress management among Australia’s nursing labor force. The assessment was performed in conjunction with the proposed guidelines for conducting evaluative reviews at Joanna Briggs Institute. Additionally, the evaluation applied various phases to manage the selection of included articles. Two authors separately examined the titles of reports and then accepted only those that met the threshold. Two reviewers independently managed to extract data, assess search results, and eliminate duplicate references. The methodological quality of all included papers was assessed independently, whereby the authors developed a critical appraisal checklist.
Results
The study identified 406 papers from all databases searched, after which 83 duplicate records were deleted. Of the nonduplicate records, 323 papers were screened for eligibility, after which 266 were excluded. The highest percentage of the study showed that most Australian nurses face significantly moderate to higher stress levels during their working shifts. Some were grouped as job-connected issues like administrative and workload issues, environmental concerns such as role conflict and job tension, patient-associated stressors like patient behavior, and professional-related factors like skills deficit.
The results highlighted workplace bullying as the primary causative agent of stress in workstations. Specifically, it can take the form of verbal and physical aggression and negative behaviors, for instance, lack of cooperation among nurses and withdrawal of necessary support by some of the nurses.
One of the impacts and outcomes of stress is that nurses encounter personal and work-related burnout. The average burnout score was 54 out of 100 of the 762 registered nurses in Australia (Badu et al., 2020, p. 15). In addition, 36.4 % (356 of 978 cases) of nurses in a study recorded moderate work-associated burnout, while 10.4% (102 of 984 cases) reported higher client-related burnout (Badu et al., 2020, p. 15). Furthermore, 22% and 66% out of a sample of 100 Australian nurses suffered severe burnout and burnout signs, respectively (Badu et al., 2020, p. 15-16). The individual attributes connected with burnout are age, period of nursing and workload, and gender. Conversely, the organizational characteristics linked with burnout are how workers’ direct voices are considered in decision making, rewards, and supervision approaches.
Moreover, the review indicated that the nurses experienced psychological detachment due to emotional labor, dissonance, and demanding work of the nursing occupation (Badu et al., 2020, p.16). Similarly, emotional work in the form of companionship contributes to positive wellbeing. Moreover, the research indicated that nurses experience anxiety and depression mainly contributed by environmental and individual aspects.
Three of the thirteen included papers concluded that the average score for resilience ranged between 58.22 to 70.02 and was assessed using a 25-item scale, rated on a five-point response scale (Badu et al., 2020, p.16). One of the individual characteristics employed to build resilience was organizing work as a conservative strategy. Mindfulness is vital, particularly when nurses detach from highly charged emotional situations and organize themselves, reflect and learn by adopting flexible schedules, lowering demands of jobs, and limiting exposure to challenging physical work. Additionally, nurses who have autonomy over their occupation can focus on providing customer-centered care and meaningful professional engagements and ultimately realize job satisfaction.
Work-life balance is another strategy used to minimize workstation stress which involves regular exercises, self-nurturing, setting emotional boundaries, and taking recreational activities. In addition, self-reliance mechanisms such as self-management skills, assertive communication, growing through adversity, and self-reflection play a crucial part in controlling stress. Moreover, positive thinking could also be applied to overcome stressful situations in the workplace, and this includes optimism and the power to think differently on ways of problem-solving.
Furthermore, emotional distancing can aid nurses in managing patient care despite the stressors originating from painful, lengthy, and traumatic care. Finally, interest and passion in nursing inspired nurses to cope with workplace adversity. For example, a nurse who develops a sense of value and pride in their professional role significantly influences them to adapt. Nurses’ workstation resiliency interventions include work-based educational policies, schemes to encourage adult resilience, and mindfulness-based stress reductions. The review findings suggested that diverse professional advancement plan strategies and working conditions should be promoted and encouraged in an Australian healthcare setting.
Limitations
This integrative review has some weaknesses that need consideration as well as proposed ways of addressing them. One of the limitations is that the study was limited to papers dealing with workplace resilience among nurses in the Australian context. Secondly, the included papers were only those published in the English language and fell from January 2008 to the end of 2018. A combination of precisely articulated search techniques, consulting research librarians, reviewing articles with various experts, and crucial appraisal tools applied to assess the methodological quality significantly helped address the above weaknesses.
Conclusion
In summary, the review shows that Australian nurses face moderate to high stress that is mainly connected to workplace bullying. The nurses are also reported to experience anxiety, burnout, and depression. The evidence indicates that numerous environmental resources and individual characteristics are used as forms of resilience to address workplace adversity. Moreover, the integrative review shows that various interventions have been piloted to enhance resilience in healthcare facilities in Australia.
Piloted measures for resiliency are practically feasible and positively welcomed to boost the wellbeing and mental health of workplace nurses. A total of 40 of the 41 papers included met the threshold for high quality and can be employed to inform strategies to address the nursing workforce. There is biasness based on gender, having most of the evidence targeting women nursing workforce and limited studies targeting males. Furthermore, the existing evidence utilizes quantitative methods, with few studies employing qualitative methods or mixed-methods approaches.
Some of the recommendations from the study are that policy planners in healthcare should use workable interventions that can enhance the psychological wellbeing and mental health of workplace nurses. Secondly, awareness and advocacy for organizational attributes and unique resources employed to facilitate resilience should be prioritized and funded in policy initiatives. Future resilience research must apply mixed methods to comprehend mental health nurses’ objective and subjective perspectives. The primary source of funding in this review is by researchers to hire additional help in reviewing articles. The funds may also be used to buy software such as Covidence, which smoothens the review process of the articles.
Reference
Badu, E., O’Brien, A. P., Mitchell, R., Rubin, M., James, C., McNeil, K., & Giles, M. (2020). Workplace stress and resilience in the Australian nursing workforce: A comprehensive integrative review. International journal of mental health nursing, 29(1), 5-34. Web.