Compose a focused paper that explains and describes your healthcare issue/topic from the scientific and mathematical/analytical perspectives of inquiry. (You will cover two perspectives in one paper.)
Address your general topic
EVIDENCE- BASED CARE SHEET
ICD-9 V62.29
ICD-10 Z56.6
Authors Mary Woten, RN, BSN
Cinahl Information Systems, Glendale, CA
Nathalie Smith, RN, MSN, CNP Cinahl Information Systems, Glendale, CA
Reviewers Carita Caple, RN, BSN, MSHS
Cinahl Information Systems, Glendale, CA
Nursing Executive Practice Council Glendale Adventist Medical Center,
Glendale, CA
Editor Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
July 6, 2018
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
Nurse Stress Index (NSI)
What We Know › Work-related stress occurs when the abilities, resources, and/or needs of an employee do
not match the requirements of his/her job(16)
• Workplace factors that increase the risk of work-related stress include a heavy workload, shift work (e.g., working evening or night shifts), poor interpersonal interactions, lack of support from colleagues and management, a nonparticipatory management style, unclear job expectations, job insecurity, inadequate training, lack of advancement opportunities, and a dangerous or unpleasant physical environment(6,14,16)
• Work-related stress can place employees at higher risk for cardiovascular disease, musculoskeletal disorders, urinary tract symptoms including overactive bladder, gastrointestinal disorders, sleep disorders, and psychological disorders(2,4,10,16,17)
› Nurses are at high risk for work-related stress(6,9)
• Work-related stress in nurses is a predictor of decreased job satisfaction, burnout (i.e., a syndrome characterized by emotional exhaustion, depersonalization [i.e., feeling withdrawn and disconnected from coworkers], cynicism, reduced perception of ability, and reduced personal accomplishment) and poor performance, and can compromise nursing care and place patients at risk(7,13)
– Healthcare organizations can increase job satisfaction among nurses by reducing sources of work-related stress(3)
– Nurse managers who have a high tolerance for stress may be less susceptible to occupational stress. Researchers performing a cross sectional study in five Brazilian hospitals found an inverse correlation between hardiness (a quality of having a stress resistant personality) and stress among 62 nurses in managerial positions(5)
– Researchers performing a quantitative systematic review of literature examining stress management interventions for nurse leaders found that interventions involving mental exercise components produced the most significant improvements in well-being. The researchers also concluded, however, that existing studies are in general of low quality(8)
– Occupational well-being in first-line nurse managers can be predicted by job demands, job control, and social support of their team and management. Investigators conducting a cross-sectional survey of 318 first-line nurse managers in Belgian hospitals found that these three factors were the top predictors of stress outcomes. The researchers concluded that hospital management should work to influence these aspects to improve working conditions and employee retention for managerial nursing staff(1)
– Researchers conducting an integrative review of 22 articles on stress and ways of coping among nurse managers found that managers generally experienced moderate stress levels, primarily from heavy workloads, lack of resources, and financial responsibilities(11)
• Work situations that nurses often perceive as stressful include(9,15)
– managing the demanding workload – Sources of stress reported by nurses include inadequate time to complete nursing
tasks and being asked to complete non-nursing tasks (e.g., clerical work)
– interprofessional conflict – Nurses report poor communication, a lack of support from other staff members, and a lack of involvement in decision
making as sources of stress – inadequate preparation for a managerial role – dealing with death and dying – instances in which they lack confidence and/or skills regarding dealing with the emotional needs of patients and family
members › The Nurse Stress Index (NSI) was developed to evaluate perceived sources of work-related stress in nurses with managerial
responsibilities (e.g., charge nurses)(9)
• The NSI is a 30-item self-report instrument consisting of six subscales, each of which measures a different domain of work-relatedstress(3,9)
– The six domains of work-related stress measured are(3,9)
– managing workload 1 (MW1) – Included in this domain are workload issues related to time management, including
– not having enough time to accomplish tasks – having to meet deadlines – staff members who demand time – urgent situations taking time away from planning – having to perform trivial tasks
– managing workload 2 (MW2) – Included in this domain are
– workload issues related to resource shortages – prioritization – interruptions that prevent working on prioritized tasks – fluctuations in workload – conflicts between nursing and managerial roles
– organizational support and involvement (OSI) – Included in this domain are
– a lack of participation in organizational changes – a lack of support from senior managers – unsatisfactory relationships with senior managers – senior managers not understanding the needs of the unit – receiving only negative feedback
– home-work conflict (HWC) – Included in this domain are
– tensions involved in balancing home and work demands – senior managers not understanding demands related to home – home demands interfering with advancement at work – the need to take time off from work to focus on home demands – being too emotionally involved in work
– confidence and competence in role (CCR) – Included in this domain are
– the ability to effect change among staff members or in the organization – having to perform tasks beyond personal skill level – adapting to new technologies – lack of specialized training – uncertainty about role responsibilities
– dealing with patients and relatives (DPR) – Included in this domain are
– dealing with difficult patients – dealing with aggressive persons – dealing with family members
– dealing with life-or-death situations – providing bereavement counseling
• The NSI is scored using a 1–5 Likert scale in which a score of 1 represents no perceived stress and a score of 5 represents extreme perceived stress(7,9)
• The NSI has been shown to have acceptable concurrent validity, internal reliability, and split-half reliability(3,7,9,14)
– There are weaknesses in the content validity of the NSI, and the NSI has not been appropriately evaluated with regard to test-retest reliability(9)
What We Can Do › Learn about work-related stress and the NSI so you can appropriately assist management personnel in assessing perceived
sources of work-related stress among nurses with managerial responsibilities and in devising strategies to decrease work-related stress; share this information with your colleagues(12)
› Participate in any research initiatives in your facility in which the NSI is used to evaluate perceived stress among nurses with managerial responsibilities
› Collaborate with your facility’s education department to provide continuing medical education on work-related stress for charge nurses and nurse managers
Coding Matrix References are rated using the following codes, listed in order of strength:
M Published meta-analysis
SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
C Case histories, case studies
G Published guidelines
RV Published review of the literature
RU Published research utilization report
QI Published quality improvement report
L Legislation
PGR Published government report
PFR Published funded report
PP Policies, procedures, protocols
X Practice exemplars, stories, opinions
GI General or background information/texts/reports
U Unpublished research, reviews, poster presentations or other such materials
CP Conference proceedings, abstracts, presentation
References 1. Adriaenssens, J., Hamelink, A., & Bogaert, P. V. (2017). Predictors of occupational stress and well-being in first-line nurse managers: A cross-sectional survey study.
International Journal of Nursing Studies, 73, 85-92. doi:10.1016/j.ijnurstu.2017.05.007 (R)
2. Borchini, R., Bertu, L., Ferrario, M. M., Veronesi, G., Bonzini, M., Dorso, M., & Cesana, G. (2015). Prolonged job strain reduces time-domain heart rate variability on both working and resting days among cardiovascular-susceptible nurses. International Journal of Occupational Medicine and Environmental Health, 28(1), 42-51. doi:10.2478/s13382-014-0289-1 (R)
3. Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nursing in Critical Care, 15(3), 129-140. doi:10.1111/j.1478-5153.2009.00384.x (R)
4. Costa, G., Anelli, M. M., Castellini, G., Fustinoni, S., & Neri, L. (2014). Stress and nurses employed in “3×8” and 2×12” fast rotating shift schedules. Chronobiology International, 31(10), 1169-1178. (R)
5. de Freitas, F. M. B., Vannuchi, M. T. O., Haddad, M. D. C. L., de Carvalho Silva, L. G., & Rossaneis, M. A. (2017). Hardiness and occupational stress in nurse managers of hospital institutions. Journal of Nursing UFPE, 10(11), 4199-4205. doi:10.5205/reuol.10712-95194-3-SM.1110sup201725 (R)
6. Elovainio, M., Kuusio, H., Aalto, A. M., Sinervo, T., & Heponiemi, T. (2010). Insecurity and shiftwork as characteristics of negative work environment: Psychosocial and behavioural mediators. Journal of Advanced Nursing, 66(5), 1080-1091. doi:10.1111/j.1365-2648.2010.05265.x (R)
7. Flanagan, N. A. (2006). Testing the relationship between job stress and satisfaction in correctional nurses. Nursing Research, 55(5), 316-327. (R)
8. Haggman-Laitila, A., & Romppanen, J. (2018). Outcomes of interventions for nurse leaders’ well-being at work: A quantitative systematic review. Journal of Advanced Nursing, 74(1), 34-44. doi:10.1111/jan.13406 (SR)
9. Harris, P. E. (1989). The Nurse Stress Index. Work & Stress, 3(4), 335-346. (R)
10. Koh, S. J., Kim, M., Oh da, Y., Kim, B. G., Lee, K. L., & Kim, J. W. (2014). Psychosocial stress in nurses with shift work is associated with functional gastrointestinal disorders. Journal of Neurogastroenterology and Motility, 20(4), 516-522. doi:10.5056/jnm14034 (R)
11. Labrague, L. J., McEnroe-Petitte, D. M., Leocadio, M. C., Van Bogaert, P., & Cummings, G. C. (2018). Stress and ways of coping among nurse managers: An integrative review. Journal of Clinical Nursing, 27(7-8), 1346-1359. doi:10.1111/jocn.14165 (RV)
12. Middaugh, D., & Willis, A. (2018). Managerial burnout: Putting out the flames. MEDSURG Nursing, 27(2), 121-122. (RV)
13. Nabirye, R. C., Brown, K. C., Pryor, E. R., & Maples, E. H. (2011). Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. Journal of Nursing Management, 19(6), 760-768. doi:10.1111/j.1365-2834.2011.01240.x (R)
14. Rodrigues, V. M. C. P., & Ferreira, A. S. S. (2011). Stressors in nurses working in intensive care units. Revista Latino-Americana de Enfermagem, 19(4), 1025-1032. doi:10.1590/S0104-11692011000400023 (R)
15. Stecker, M., & Stecker, M. M. (2014). Disruptive staff interactions: A serious source of inter-provider conflict and stress in health care settings. Issues in Mental Health Nursing, 35(7), 533-541. doi:10.3109/01612840.2014.891678 (R)
16. United States Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Health and Safety (NIOSH). (2014, June 6). Stress at work (DHHS [NIOSH] Publication No. 99-101. Retrieved June 26, 2018, from http://www.cdc.gov/niosh/docs/99-101/ (GI)
17. Zhang, C., Hai, T., Yu, L., Lui, S., Li, Q., Zhang, X., & Wang, X. (2013). Association between occupational stress and risk of overactive bladder and other lower urinary symptoms: A cross-sectional study of female nurses in China. Neurourology and Urodynamics
by forming and answering two levels of research questions for each inquiry.
- Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.
- Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.
- State your research questions in the introduction of your paper.
- Answer each research question and support your assertions with evidence (research) to form the body of your paper.
- In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.
Level 1 Research Questions/Writing Prompts
SCIENTIFIC Perspective of Inquiry
What are the anatomical, physiological, pathological, or epidemiological issues?
Which body systems are affected?
What happens at the cellular or genetic level?
Which chemical or biological issues are most important?
Level 1 Research Questions/Writing Prompts
MATHEMATICAL/ANALYTICAL Perspective of Inquiry
What are the economic issues involved?
Which economic theories or approaches best explain the issue?
What are the statistical facts related to the issue?
Which statistical processes used to study the issue provide for the best explanation or understanding?
Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow current APA Style (e.g., spacing, font, headers, titles, abstracts, page numbering).
Refer to the rubric for evaluation details and to assist in preparing the paper.
