How effective are stress management interventions for the nursing population?

What is it about?

Background: Nursing is considered one of the most demanding occupations and includes a high risk to develop stress-related outcomes such as burnout, depression, and post-traumatic stress disorder. In turn, poor mental well-being can have negative effects on the nurse themselves, the patient they are treating and the wider organization (e.g. increased absenteeism and turnover). This problem has prompted many researchers to study ways to reduce stress levels in nurses, from mindfulness mediation to assertiveness training and the implementation of lean processes. Still, the question remains - how effective are these programs and what characteristics relate to greater effectiveness? Summary of the most important findings: In the current literature review we identified 85 articles published over the past 14 years (2007-2021), assessing the effectiveness of a stress management intervention for the nursing population. Of the interventions studied, 74 included a person-directed approach (e.g. improving nurses` coping, relaxation or work skills) and only 9 (also) targeted the working environment. This is an interesting finding, as many studies have indicated that workplace factors, including worktime demands and staffing problems, are (the main) predictors of stress and stress-related outcomes in nurses. Suggesting that, up till now, little research has been done focusing on how we can reduce the causes of stress in this setting. Based on the results of the current review, we can conclude that stress management interventions are effective in reducing stress-related outcomes in nurses, at least on a short-term basis (directly up till one month after the intervention). With only a few studies conducting follow-up measurements, we know little about the longevity of their effects on nurses` stress levels and well-being. Person-directed interventions (e.g. mindfulness/relaxation training, cognitive behavioral therapy, assertiveness training) showed to be effective, but mostly on short-term basis and for milder stress symptoms such as work-related stress. In the treatment of more severe stress reactions, including symptoms of burnout and post-traumatic stress, professional support may be necessary. With regard to effective characteristics, interventions with higher attendance of employees and a target group consisting of solely nurses rather than including other healthcare professionals, were more effective. Other studied characteristics - the type of intervention (based on cognitive behavioral techniques, relaxation, work skills or a mix), the length of the intervention, whether or not the intervention focused on nurses with current stress-related complaints, and the type of control group used - did not relate to greater effectiveness. The few interventions (also) focusing on improving the working environment (i.e. interventions that aim to reduce demands and increase job resources) reached small short-term effects. In line with the person-directed interventions, their long-term effects on nurses` stress levels remained unclear. Considering their preventative approach, it is likely that it will take time until the positive effects of changes made in the working environment, will be reflected in nurses’ well-being. In addition, as organization-directed interventions are far more focused on targeting the underlying causes of stress, their effects are expected to be more sustainable than those of person-directed interventions. Future research: In terms of future research, more long-term measurements are necessary to gain a better understanding of the longevity of the effects of stress management interventions. In addition, better reporting is important to enable the identification of other potential characteristics that may relate to greater effectiveness (e.g. the involvement of employees in designing and implementing the intervention ). Finally, there is a lack of studies focusing on an organization-directed approach towards stress management. An approach with a lot of potential but still limited research foundation. Although, these interventions often require a prolonged time investment and are more disruptive to the status quo of an organization, they have a far greater reach than person-directed interventions and their effects are likely to be more sustainable. Practical implications: In terms of practical recommendations, care must be taken. Although the current review suggests that person-directed interventions are effective on a short-term basis, harm may be done when e.g. mindfulness or relaxation is offered to a nurse, without acknowledging the stress-inducing work environment. This may result in victim blaming, including wrongfully suggesting that the problem arises due to a lack of coping skills of the employee. This can even lead to more negative outcomes; employees might start to doubting their abilities and/or may reconsider their choice of career. In terms of best practices, it is recommended to focus on both: Preventing future stress-related outcomes by optimizing the working environment, while providing support for individuals who already experience stress-related outcomes.

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Photo by Vladimir Fedotov on Unsplash

Photo by Vladimir Fedotov on Unsplash

Why is it important?

Nurses are considered to have one of the most demanding professions and are at risk of developing stress-related outcomes. As a result, many stress management interventions have been published in the literature, but there is a lack of a systematic quantitative approach to assess their effectiveness. The present study uses meta-analytic techniques to evaluate their overall effectiveness and to identify characteristics related to greater intervention success.

Perspectives