Features of Academic Writing

Arén et al. BMC Nursing(2022) 21:296 https://doi.org/10.1186/s12912-022-01059-x BMC Nursing RESEARCHOpen AccessRESEARCHOpen Access 6479998-27804The work-related stress experienced by registered nurses at municipal aged care facilities during the COVID-19 pandemic: a qualitative interview study Cilmara Arén1, Armand Jaçelli1, Berit Gesar1 and Ingrid From1* 720090134620AbstractBackground Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways.Aim The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities.Methods Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study.Results The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute towork-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment.Conclusion This study showed the everyday experiences of registered nurses’ stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study to reduce the risk of further increasing the work- related stress experienced by registered nurses working in municipal aged care.Keywords Experiences, Nursing care, Older people, Registered nurse, Work-related stress00AbstractBackground Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways.Aim The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities.Methods Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study.Results The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute towork-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment.Conclusion This study showed the everyday experiences of registered nurses’ stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study to reduce the risk of further increasing the work- related stress experienced by registered nurses working in municipal aged care.Keywords Experiences, Nursing care, Older people, Registered nurse, Work-related stress 72390015494000 *Correspondence: Ingrid From [email protected] 1School of Health and Welfare, Dalarna University, Falun, Sweden 11887201085850070993011366500© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Background The World Health Organization, WHO (2017) has clas- sified stress as the “health epidemic of the 21st century” and stated that work-related stress is the reaction that people may have when presented with work demands and pressures beyond their experience and capabilities. Personal stress arises in a wide range of work situations when employees feel they haveinsufficient support from managers and colleagues and inadequate control over work processes [1]. Stressors of emotional or physical tension are described by Yao et al. [2] as any event or thought that trigger people to feel frustrated, angry, or nervous. Previous research points out that registered nurses working in municipal care experience different work- related stressors, impacting their physical and men- tal well-being [3, 4]. Understaffing and the lack of good relationships at work between colleagues, such as differ- ent views and experience, can negatively affect mental health [3, 5]. Registered nurses’ health in older people’s care affects the quality of patient care and safety. Work- ing under severe stress is one of the reasons for absence from work [6]. Additionally, Fang et al. [7] describe how registered nurses who feel a significant commitment to their work can become too committed, leading to increased work-related stress. Work-related stress is the most important contributor to poor work satisfaction [7]. According to Hassan et al. [8] and van Steijn et al. [9], work-related stress contributes to work-related diseases as anxiety and depression. The setup of the organization and lack of support from management both in emergency care [6] and care of older people in a local municipality complex and may cause stress [10]. Work-related stress is an increasing problem associated with dysfunctional workplaces [11]. Anshasi et al. [12] described the fact that there is a significant need for competence development in older people’s care among nursing staff in municipal care facilities. Organi- zations must improve the work situation to increase an employee’s health-related quality of life without stress. Programs to improve quality of life without stress should focus on promoting continuous education for their employees, positive relationships between colleagues, social support, and stress-reduction courses [13]. Work-related stress among registered nurses raises sig- nificant concerns about patient safety, nurses’ attitudes toward their patients in nursing homes and aged care facilities, and the quality of aged care [14, 15]. The inter- nal stressors can contribute to the work sometimes being carelessly done, leading to an increased risk of making serious mistakes [16]. People perceive and handle stress- ful situations in different ways because humans are dif- ferent and experience things differently [16]. Bittinger et al. [17] describe work-related stress as dangerous and harmful for registered nurses’ work situation. Counter- acting this may be the key to reduce the adverse effects working in a stressful situation with the risk of reducing quality of life. Furthermore, studies have shown that a long period with a heavy workload can cause many other negative impacts, such as critical incidents or high staff turn- over among registered nurses [14, 15]. According to Antonovsky [18] the experience of feeling connected, the Sense of Coherence, determines what degree of mental health the individual can feel. In the demand-control- support model by Karasek and Theorell (1990), they describe the relationship between health and working life stress. This model shows which conditions in the work environment can decrease stress. The main concepts are demand, control, and social support. The authors empha- size the importance of a social network in reducing work- related stress and how it can help to reduce the risk of illness in the workplace [19]. Staff shortages and understaffing in nursing are prob- lematic and can negatively affect the quality of care. Nurses should have satisfactory working conditions and therefore it is essential to identify sources of stress affecting registered nurses [20]. People are suffering from work-related stress conditions and there is a need to be more proactive in reducing work-related stress [1]. Work-related stress for a registered nurse has proven to be a danger to patient safety and quality of care as well as to the nurse’s own physical or mental well-being and it can lead to them becoming overworked and a decreased quality of life. To understand work-related stress condi- tions, it is essential to study nurses’ experiences of work- related stress. According to our knowledge, few studies have focused on stress among nurses in municipal care. Aim The purpose of this study was to describe the registered nurses’ experiences of work-related stress in the care of older people at municipal aged care facilities. Method Design This study was an empirical qualitative study based on semi-structured interviews [21]. The data was ana- lyzed with qualitative content analysis according to the description by Graneheim and Lundman [22]. Qualita- tive content analysis can help and show conflicting opin- ions or unsolved issues regarding the meaning and use of concepts, procedures, and interpretation. Using this method provides an important overview of the main con- cepts related to qualitative content analysis [22]. Sample selection The selection of participants was made using convenience sampling because the data was collected in six different municipal aged care facilities in Sweden [21]. Inclusion criteria for participation in the study were that registered nurses should have worked for at least one year or more in an aged care facility. No criteria for exclusion were applied. All participants were registered nurses who had between 1–40 years’ nursing experience which included the experience of working in aged care at a municipal care facility. Twelve registered nurses participated in the study. Seven of the participants were women and five were men. They were all aged between 25–70. Seven had advanced nurse practitioner qualifications and five had a registered nurse qualification. The selected sample is rep- resentative of this group characteristic according to gen- der and age distribution and experiences. The aim was to obtain a good heterogeneity, and this was easily achieved due to the multiple diversity of the gender, age, and expe- rience of our participants in the conducted interviews. Also, to maximize the variety of the participants and respond to the relevant research question. Before starting the interviews’, written information was provided, and a written consent form was signed by the manager of the respective facility. After consideration, the interested reg- istered nurses contacted the authors and accepted partic- ipation by signing and returning a letter of consent. Data collection The interviews were carried out at the participant’s work- place. All the participants in the study were informed that they could discontinue the participation at any time without stating the reason. According to Polit & Beck [21] a semi-structured interview is an interview based on several open questions of the phenomenon being investigated. Eight open questions were chosen to be relevant to the study with one or more follow-up ques- tions on the same question to gain a deeper insight into the area of interest studied. The questions were about stress situations at work and covered their daily work in general but also more detailed discussions of when and why stressful situations occurred and how they handled them. The interview included guide the follow- ing questions: ‘Describe your working experiences as a nurse in a municipal care for old people’, ‘describe what work-related stress means for you´ and ‘does the work- related stress affect your quality of life? Describe how’. All interviews were conducted in Sweden, in March 2021. Informed consent was obtained, both orally and in writ- ing, before the start of the interview. One of the authors (CA) was responsible for booking interview times with the participants. They also carried out all the individ- ual interviews. The data collection was done through the help of an interview guide according to [21]. All the Table 1 Examples of meaning units, condensed meaning units and codes Meaning units Condensed meaning Codes Then you can get physical problems such as, gastritis or palpitations or that you sweat or something and you feel stressed. Stress can cause various physical problems such as gastritis, palpita- tions, or sweating. Stress can cause physical problems. There is also a stress and pressure, and you have patient safety and must pri- oritize as the managers say prioritize, prioritize and it is difficult and what should we prioritize when we have our system that the municipality has established. Stress and pressure, patient safety, man- agers say prioritize, but the municipal- ity has established a system. Stress due to prioritiza- tion dur- ing low staffing periods. interviews took place in private rooms and non-disturb sign was placed outside the door to minimize the risk of errors during the interviews. The individual interviews lasted about 4045 minutes and were recorded using a digital voice recorder and transcribed verbatim. Data analysis The qualitative content analysis method used was accord- ing to Graneheim and Lundman [22]. The interviews were listened to several times by two authors (CA, AJ) independently and transcribed into text. The transcribed text content was divided into areas based on the research questions. Parts of the content related to the aim were set as meaning units that were then condensed and coded. See an overview in Table 1. The codes were compared to identify and describe variations and similarities in the textual content to answer the aim of the study. Parts of the text content that responded to the aim were removed and set as meaning units that were then condensed and coded in the end. The codes were compared to identify and describe variations and similarities in the textual content to answer the study’s aim, as was described by Graneheim and Lundman [22]. To ensure the credibility of the codes, they would be ch...