BACKGROUND: Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained.
AIM: The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies.
METHOD: A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided.
RESULTS: The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies.
CONCLUSIONS: The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.

A systematic review of stress and stress management interventions for mental health nurses

Aim: This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing. Background: Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable. Method: Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study. Results: One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used. Conclusions: Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis

Use of factor analysis in Journal of Advanced Nursing: literature review

Staff burnout in dementia care--relations to empathy and attitudes.

Title. Evaluation of empathy measurement tools in nursing: systematic review.

Aim.  This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a ‘gold standard’ for application in future studies.

Background.  Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves.

Data sources.  An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords ‘empathy’, ‘tool’, ‘scale’, ‘measure’, ‘nurse’ and ‘nursing’. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.

Method.  Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0–14 for each measure.

Results.  Quality scores obtained were low (2–8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.

Conclusion.  Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users’ own perspectives and be tested with appropriate populations in relevant care settings.

Evaluation of empathy measurement tools in nursing: systematic review.

Background. Although burnout among nurses has been studied in a great deal, this work has not included Korean nurses. Furthermore, the role of personal resources such as empathy and empowerment in predicting the variance in burnout has never been examined.



Aim.  The purpose of this study was to understand the phenomenon of burnout among Korean nurses. A comprehensive model of burnout was examined to identify significant predictors among individual characteristics, job stress and personal resource, with the intention of providing a basis for individual and organizational interventions to reduce levels of burnout experienced by Korean nurses.



Methods.  A cross-sectional correlational design was used. A sample of 178 nurses from general hospitals in southern Korea was surveyed from May 1999 to March 2000. The data were collected using paper and pencil self-rating questionnaires and analysed using descriptive statistics, Pearson correlations, and hierarchical multiple regression.



Results.  Korean nurses reported higher levels of burnout than nurses in western countries such as Germany, Canada, the United Kingdom and the United States of America. Nurses who experienced higher job stress, showed lower cognitive empathy and empowerment, and worked in night shifts at tertiary hospitals were more likely to experience burnout.



Conclusions.  Identifying a comprehensive model of burnout among Korean nurses is an essential step to develop effective managerial strategies to reduce the problem. Suggestions to reduce the level of burnout include enhancing nurses’ cognitive empathy and perceived power, providing clear job descriptions and work expectations, and exploring nurses’ shift preferences, especially at tertiary hospitals. In future research we recommend recruiting nurses from broader geographical areas using random selection in order to increase the generalizability of the findings.

A comprehensive model for predicting burnout in Korean nurses.

A non-anonymous questionnaire was distributed to all nursing staff (n = 557) including RNs, LPNs (psychiatric), LPNs (somatic) and nurses' aides, in one nursing home, one somatic long-term care clinic and one psychogeriatric clinic. Scales measuring empathy, burnout experience and attitudes towards demented patients were included in the questionnaire. The aim of the study was to compare levels of empathy, burnout experience and attitudes among different categories of nursing staff and to examine connections between empathy, burnout and attitudes. The nursing staff showed an overall figure of moderately well-developed empathy and the RNs showed the highest empathy. The RNs had a significantly lower degree of burnout compared to the nurses' aides and the LPNs. Of all respondents, 27.4% were assessed at risk from burnout. Overall, the staff showed a moderately positive attitude towards demented patients and the RNs were most positive. No linear correlation was found between empathy, burnout experience and attitudes. However, a weak negative correlation between burnout and empathy is in accordance with other authors who are suggesting that burnout experience leads to lower empathy in the nursing staff. The fact that the RNs showed the most positive attitudes towards demented patients and had the highest level of empathy compared to LPNs and nurses' aides could be related to lower degree of burnout assessed in the RNs. Qualitative and quantitative overload among the LPNs and nurses' aides connected to the growing number of demented patients in the institutions examined are discussed.

Shire Àstrom

Papers

Empathy, experience of burnout and attitudes towards demented patients among nursing staff in geriatric care.