Stressors Affecting Healthcare Professionals
Workplace stress among healthcare professionals represents a serious threat to the fourth goal of the extended Triple Aim of care delivery. Registered nurses (RNs) working in psychiatric units are particularly prone to job stress because of the elevated risks in this environment. They have to manage elevated challenging behaviors, persuade patients to take medication, and prevent self-injury, which is absent in general units. Severely ill patients often display aggressive behavior, including verbal abuse, spitting, and physical assault, towards RNs (Wu et al., 2020). Thus, unresolved challenging situations and patient aggression are key traumatic stressors for psychiatric nurses. Kobayashi et al. (2020) also found that experiencing an assault increases the risk of post-traumatic stress symptoms, causing long-term adverse psychological consequences on RNs. Therefore, patient violence and aggression are not merely brief traumatic experiences but enduring stressors for RNs in psychiatric wards.
Job-related factors also contribute to high levels of stress among psychiatric nurses. Alyousef (2019) found hostility and discrimination from other staff as the key psychosocial stressors routinely experienced by mental health nursing students in their clinical learning environments. Further, interprofessional conflict may impede the resolution of challenging situations and aggravate work-related stress. In the wake of COVID-19, inadequate preparedness among psychiatric RNs to identify symptoms or protect themselves made their work very challenging and stressful (Wu et al., 2020). Professional role conflict, especially when confronted with epidemics that need collaborative interventions, impacts the psychological outcomes of nurses.
Another key stressor for psychiatric nurses is poor work-life balance. Heavy workloads due to high nurse-patient contact in mental health wards mean less time is available for social and family obligations (Kobayashi et al., 2020). This factor became a significant stressor during the pandemic, as nurses struggled to attend to familial responsibilities and were overwhelmed with professional demands. Burnout and the fear of transmitting the virus to their family members were other sources of stress (Wu et al., 2020). Delayed career progression and limited psychosocial support resources also may predispose psychiatric nurses to significant levels of distress.
Improving the Impact of the Stressors
Ameliorating the impact of key stressors on psychiatric nurses will improve their psychosocial outcomes and daily functioning. In a psychiatric setting, enhancing de-escalation skills among RNs will lower the risk of assault or injury, reducing absenteeism or days off that impact the quality of care (Alyousef, 2019). In addition, teaching coping strategies will boost staff morale and enhance the capacity of RNs to recognize and address stressors early to reduce their impact on performance and productivity.
When RNs work multiple shifts or for long hours, they are likely to experience burnout and poor mental health. Burnout is considered an outcome of unmanaged workplace stress that manifests as extreme exhaustion, negative attitudes towards one’s professional role, and feelings of lower self-efficacy (Kobayashi et al., 2020). It can be minimized by addressing key risk factors, such as work overload and patient violence, which also cause poorer psychological status among psychiatric nurses. Minimizing RN exposure to aggressive behavior or incidents in a psychiatric context would reduce secondary traumatic stress (STS) symptoms (Alyousef, 2019). Decreasing the severity of STS will improve the nurses’ wellbeing and job satisfaction and alleviate absenteeism and turnover, which will impact patient safety and quality of care positively.
Methods for Decreasing Provider Stress
Enhancing the resilience of nurses to stress is critical since alleviating all stressors may not be possible in a psychiatric context. Building the individual capacity to recover and ensure a healthier response to work-related challenges, including patient aggression, or interpersonal difficulties that cause stress is important. Velana and Rinkenauer (2021) note that improving nursing resources and support will strengthen individual capacities to handle stress and job-related stressors. The aim is to build coping strategies and resilience in health care providers.
Many hospitals have adopted individual-level interventions aimed at nurse empowerment to deal with challenges in the workplace and promote RNs’ mental wellbeing. Mindfulness-based stress reduction (MBSR) has been shown to reduce stress and burnout among health care professionals (Kriakous et al., 2021). It entails quiet contemplation and a deliberate focus on the current experiences without being judgmental and free from unhelpful thoughts. It leads to a greater sense of awareness and calmness under stressful situations. MBSR is a group intervention where participants engage in a weekly 6-hour meditation, walking, or yoga (Kriakous et al., 2021). It leads to a positive change in perspective about one’s situation, resulting in improved psychological outcomes.
Other techniques that may help RNs reduce stress include mindful meditation and relaxation methods. It allows individuals to explore their thoughts and emotions in order to calm down and approach stressful situations objectively without focusing on one’s shortcomings or negative thoughts (Velana & Rinkenauer, 2021). Such focused interventions also improve cognitive functioning, morale, and performance. Training in coping skills is another effective method for dealing with stress among nurses (Kriakous et al., 2021). Interventions with cognitive-behavioral therapy (CBT) components may help RNs recognize stressors, learn self-care skills, and work through difficult and stressful situations. These programs are increasingly being delivered efficiently by technologies, such as virtual reality.
References
Alyousef, S. M. (2019). Psychosocial stress factors among mental health nursing students in KSAA.Journal of Taibah University Medical Sciences, 14(1), 60-66. Web.
Kobayashi, Y., Oe, M., Ishida, T., Matsuoka, M., Chiba, H., & Uchimura, N. (2020). Workplace violence and its effects on burnout and secondary traumatic stress among mental healthcare nurses in Japan.International Journal of Environmental Research and Public Health,17(8), 1-12. Web.
Kriakous, S. A., Elliot, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review.Mindfulness, 12(1), 1-28. Web.
Velana, M., & Rinkenauer, G. (2021). Individual-level interventions for decreasing job-related stress and enhancing coping strategies among nurses: A systematic review. Frontiers in Psychology, 12, 1-13. Web.
Wu, D., Jiang, C., He, C., Li, C., Yang, L., & Yue, Y. (2020). Stressors of nurses in psychiatric hospitals during the COVID-19 outbreak. Psychiatry Research, 288, 1-4. Web.